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Changes to the State of Alaska First Report of Injury Forms

Monday, July 1, 2013

The State of Alaska, Division of Workers’ Compensation has made changes to their First Report of Injury Forms.

The employee and the employer will be required to fill out separate forms to first report an occupational injury or illness. Alaska Workers Compensation Board (AWCB) confirms these new forms should be used for all new injury reports starting July 22, 2013.

On the old form (Form 07-6101 Rev 08-2012) the employee and employer sections were both on the same page. The new forms are:

07-6100 -- Employees Report of Occupational Injury or Illness to the Employer

07-6101 – Employer Report of Occupational Injury or Illness to Division of Workers’ Compensation

The State also issuedan instruction sheet on the use of these forms and advises employers that items #13, 15, 16, 17 on form 6101 can be completed by APEI, anditem #14 will be populated by the AWCB upon acceptance of the claim.

APEI felt it was important to provide all members immediate awareness and access to these forms, so you can become familiar with these new requirements.

Please make sure you send both new forms to APEI for our handling.

Updates by the State of Alaska can be found at http://www.labor.state.ak.us/wc/

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ALASKA PUBLIC ENTITY INSURANCE
2233 Jordan Ave. 
Juneau, AK 99801
Toll Free: 877-586-2734
Phone: 907-523-9400
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Alaska Public Entity Insurance

2233 Jordan Ave
Juneau, AK 99801-8050

Phone: 907-523-9400

Toll-Free: 877-586-2734

Fax: 907-586-2008