Resources

Here are forms for employers to use to file and manage claims. If you have questions about a form, our Claims Department can assist you. Call us at 208-8210.

Employee’s Report of Injury

WC-1 Form – Employer’s Report of Industrial Injury (PDF)

WC-14 – Employee’s Wage Report for 52 Weeks Prior to Date of Injury (PDF)

WC-1 for CBWC Program – Employer’s Report of Industrial Injury for Collectively Bargained Workers’ Comp Program (PDF)

Return to Work Agreement – Modified/Light Duty (PDF)

Medical Certificate Report

Hawai`i Workers’ Compensation Law Highlights (PDF)

Job Analysis Form for Employers

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