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

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

Used by only self-insured employers or their representatives to report initial time loss payments or to request interlocutory, wage, overpayment or closure orders.

Document number F207-005-000
How to get this document
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, SIF5, time loss compensation, time-loss compensation, wages, worker's compensation, workers compensation, workers' compensation
Alt Language(s)
Valid dates 09/2007
Contact information Claims for Job Injuries, Employer Services, Employer Services
Related information

SIF-5A Cover Sheet: Wage Calculations

Websites Checklists & Instructions for self-insurers, Insurance for Business, Self-Insured Employers

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