Self-Insurance Report of Occupational Injury or Disease (SIF-5)

Document Information
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Title Self-Insurance Report of Occupational Injury or Disease (SIF-5) (A fillable form - 169 KB PDF)
Description Used by only self-insured employers or their representatives to report initial time loss payments or to request interlocutory, wage, overpayment or closure orders.
Detail
Form number F207-005-000
Availability
Online only. See document above to download.
Keywords claim information, claims, closure, diseases, industrial insurance, interlocutory, occupational diseases, occupational injuries, report injury, report of accident, reporting accidents, self insurance, self insurer, self-insurer, time loss compensation, time-loss compensation, wages, worker's compensation, workers compensation, workers' compensation
Languages English
Valid dates 09-2007
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Self-Insurance
Related information
Documents

SIF-5A Cover Sheet: Wage Calculations
Web pages Self-Insured Employers
Insurance for Business
Checklists & Instructions for self-insurers

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