Board Forms Related Links
Board Forms
The Board forms are available in a fillable format for printing or downloading a copy to your storage media. If you have any questions, please call the Board’s Call Center at 404-656-3818 or 1-800-533-0682.
Beginning October 1, 2025, outdated forms will be returned.
| FORM | REVISION DATE | TITLE |
|---|---|---|
WC-BOR
| 2023 | Bill of Rights |
|
WC-BOR-Sp
| 2023 | Bill of Rights - Spanish (Declaración de Derechos en Español) |
|
WC-P1
| 2023 | Panel of Physicians |
|
WC-P1Sp
| 2023 | Panel of Physicians - Spanish (Panel de Medicas en Español) |
|
WC-P3
| 2022 | WC/MCO Panel |
|
WC-P3Sp
| 2023 | WC/MCO Panel - Spanish (Panel WC/MCO en Español) |
|
WC-1
| 2021 | Employer's First Report of Injury |
|
WC-2
| 2023 | Notice of Payment or Suspension of Benefits |
|
WC-2a
| 2025 | Notice of Payment or Suspension of Death Benefits |
|
WC-3
| 2021 | Notice to Controvert |
|
WC-4
| 2021 | Case Progress Report |
|
WC-6
| 2018 | Wage Statement |
| WC-7 | Application for Self Insurance (Packet available through Licensure & Self-Insurance Division (404) 651-7839 | |
|
WC-10
| 2023 | Notice of Election or Rejection of Workers' Compensation Coverage |
|
WC-11
| 2021 | Standard Coverage Form Group Self-Insurance Fund Members |
|
WC-12
| 2022 | Request for Copy of Board Records |
|
WC-14
| 2022 | Notice of Claim/Request for Hearing/Request for Mediation |
|
WC-14a
| 2022 | Request to Change Information on a Previously Filed Form WC-14 |
|
WC-15
| 2018 | Attorney Certification for No-Liability Stipulations |
|
WC-20a
| 2018 | Medical Report |
|
WC-25
| 2022 | Application/Objection for Lump Sum/Advance Payment |
|
WC-26
| 2023 | Consolidated Yearly Report of Medical Only Cases/Indemnity Cases |
|
WC-100
| 2018 | Request for Settlement Mediation |
|
WC-102
| 2021 | Request for Documents to Parties |
|
WC-102b
| 2018 | Notice of Representation |
|
WC-102c
| 2018 | Attorney Leave of Absence |
|
WC-102d
| 2021 | Motion/Objection to Motion |
|
WC-104
| 2018 | Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations |
|
WC-108a
| 2018 | Attorney Fee Approval |
|
WC-108b
| 2021 | Attorney Withdrawal/Lien |
|
WC-121
| 2024 | Notice of Change of TPA/Servicing Agent |
|
WC-131
| 2023 | Application for Permit to Write Insurance |
|
WC-131a
| 2023 | Annual Insurer Update |
|
WC-200a
| 2025 | Change of Physician/Additional Treatment by Consent |
|
WC-200b
| 2021 | Request/Objection for Change of Physician/Additional Treatment |
|
WC-205
| 2021 | Request for Authorization of Treatment or Testing by Authorized Medical Provider |
|
WC-206
| 2021 | Request to Become a Party at Interest |
|
WC-207
| 2025 | Authorization and Consent to Release Information |
| WC-208 | Application for Certification of WC/MCO (Packet available through Managed Care & Rehabilitation Division (404) 656-0849) | |
|
WC-226a
| 2024 | Petition for Appointment of Temporary Conservator of Minor(s) |
|
WC-226b
| 2024 | Petition for Appointment of Temporary Conservator of Legally Incapacitated Adult |
|
WC-240
| 2021 | Notice to Employee of Offer of Suitable Employment |
|
WC-240a
| 2018 | Job Analysis |
|
WC-243
| 2021 | Credit |
|
WC-244
| 2021 | Request to Become a Party at Interest |
|
WC-262
| 2021 | Wage Documentation of Temporary Partial Disability Payments |
|
WC-PMT
| 2023 | Petition to Show Cause Regarding Medical Treatment/Testing Recommended by Authorized Medical Provider |
|
WC-PMT(b)
| 2024 | Petition to Show Cause Regarding Medical Treatment/Employee’s Failure to Attend Medical Appointment with an Authorized Treating Physician |
|
WC-R1
| 2022 | Request for Rehabilitation |
|
WC-R1CATEE
| 2022 | Employee's Request for Catastrophic Designation |
|
WC-R2
| 2022 | Rehabilitation Transmittal Form |
|
WC-R2a
| 2022 | Individualized Rehabilitation Plan |
|
WC-R3
| 2022 | Request for Rehabilitation Closure |
|
WC-R5
| 2021 | Request for Rehab Conference |
|
Rehab
Objection
| 2018 | Rehab Objection |
|
Rehab
Release
| 2021 | Catastrophic Rehab Release |
|
Change
of Address
| 2021 | Request for Change of Address |
|
Change
of Information
| 2022 | Request to Change Information |
|
Subpoena
| 2021 | Subpoena |