The form listed below is the official New Hampshire State Form. Your employer may have an incident report of their own for filing information with the insurance carrier about an on-the-job injury

This form should be completed and a copy given to your employer.

Should your employer refuse to acknowledge same, please return both copies to the New Hampshire Department of Labor immediately with a letter so stating your employer's refusal. Please return to the Workers' Compensation Claims Division attention.

WORKERS' COMPENSATION FORMS

• Notice of Accidental Injury Or Occupational Disease (8aWCA)
  (online form)


• Notice of Accidental Injury Or Occupational Disease (8aWCA)
  (download)