Forms
Claims - AMW Statutory Maximum for 2018
… AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: …
Claims Employee Revocation of Rejection of Terms Form
… employees have elected to be subject to the provisions of Arizona’s workers’ compensation laws. However, an employee is …
… THE INDUSTRIAL COMMISSION OF ARIZONA INDUSTRIAL COMMISSION OF … like to have the certificate of insurance to read. Please fill out all areas highlighted in …
Commission publishes revised Notice of Claim Status (Form 104 - Rev 01/2016) - use of new form is mandatory effective March 1, 2016.
… Commission publishes revised Notice of Claim Status (Form 104 - …
… Keep Copy THIS FORM APPROVED BY THE INDUSTRIAL COMMISSION OF ARIZONA Claims ICA 0124-Rev … have any open cuts, sores, rashes, or other breaks/ruptures in your skin or mucous membrane …
Compliance Assistance Request Instructions
… An employer may request a free compliance assistance activity or visit for a … information, contact ADOSH toll free at (855) 268-5251 or (602) 542-5795 (Phoenix) or (520) …
ADOSH - List of Authorized Companies for Boiler Inspections
… Arizona Division of Occupational Safety and Health (ADOSH) Boiler Safety Section Brian … Phone: (602) 542-5795 Toll Free: (855) 268-5251 FAX: (602) 542-1614 Tucson Office 2675 …
Claims - About Loss of Job or Loss of Earning Capacity
… AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: …
claims-seminar-material
… 2021 Claims Seminar Manual Download Handout 1 - Is It Compensable Download Handout 2 - France V ICA …