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RESOURCES
 
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Document Request

Please enter the following information to request documents to be sent to you. Additional forms are available for download on our Downloadable Forms web page.
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IDForm NameQty
1Employee Application for Temporary Total Disability Benefits
3Claim for Home Nursing Services
4Claim for Non-Medical Services
5Claim for Pharmacy/Medical Supplies
7Reimbursement Vouchers
8Pamphlet for Injured Workers
9Wyoming Report of Injury
10Health Care Provider Initial Report
11Request for change of Health Care Provider
12ERs Guide to Reporting and EEs Injury
13Return to Work Booklet
22Employees Guide To Reporting an Injury
24Employers Guide to Workers Safety and Compensation
56Employers Guide To Drug Free Workplace Program
61Joint Program Pamphlet
71Release of Information
72Trauma of Disability
95First Fill Form (HealthESystems)


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