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Beginning October 1, 2025, outdated forms will be returned.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 - Español) |
| WC-P1 | 2023 | Panel of Physicians |
| WC-P1Sp | 2023 | Panel of Physicians - Spanish (Panel de Medicas - Español) |
| WC-P3 | 2022 | WC/MCO Panel |
| WC-P3Sp | 2023 | WC/MCO Panel - Spanish (Panel WC/MCO - Español) |
| WC-1 | 2021 | Employer's First Report of Injury |
| WC-1Sp | 2021 | Employer's First Report of Injury (Primer informe del empleador sobre la lesión - Español) |
| 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-14Sp | 2022 | Notice of Claim/Request for Hearing/Request for Mediation - Spanish Aviso de reclamación/Solicitud de audiencia/Solicitud de mediación - Español |
| 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 Medical Information |
| WC-207-Sp | 2025 | Authorization and Consent to Release Medical Information - Spanish (Autorización y Consentimiento para Revelar Información Médica - Español) |
| 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 |