Please mail accident reports to our Springfield office: 701 S. 2nd St., Springfield, IL 62704. 
Please mail settlement contracts to the assigned arbitrator. 
Please mail all other forms to our Chicago office: 100 W. Randolph St. #8-200, Chicago, IL 60601.

Unless noted otherwise, the forms were last revised in 12/2004.  Whenever we create a new form, we allow six months from the revision date for parties to make the transition.  After that, forms may be returned to the filing party. 

Copies of the forms are available in the Chicago Reception Area and all Downstate offices. If you would like to receive the forms by mail, call the Chicago Mail Room at 312/814-6633.

Please be sure to fill in all fields.  We must have complete mailing addresses for all parties.

Word Versions

The Word forms are set up as fill-in-the-blank forms. You can tab through the fields, type in your answers, print (try Print/Scale to Paper Size) and save the document (go to File/Save As).

You can modify the forms.  The Word forms are password-protected. That means if the format suits you, type in your answers and don't bother with the password. To change the formatting of a Word document, go to Tools/Unprotect Document; type in the password (iwcc (lower case)) and you can change the entire document. If you are having problems, check the settings on File/Page Setup.  If the box is checked for a custom paper size, unclick it.  You want a letter-size document with .5" margins. 

You may reproduce our forms as long as you create reasonably exact duplicates in layout, font, size of type, etc. (Boxes and lines for check marks are both OK.)  Make sure your version of a form matches ours. You must use colored paper if we use it; please match the color as closely as possible. Forms that do not comply with our standards will be returned to the filing party. The state seal can be reproduced on the condition that the seal is used only on forms filed with the Commission and for no other purpose, as provided by law.

If you don't have Microsoft Word, you can download the free Word Viewer, and then save the document in the software version you do have.

Adobe/PDF Versions

The PDF forms are set up as fill-in-the-blank forms. You can tab through the fields, type in your answers, and print.

PDF forms are designed to fit different printers, so you should not have problems with the formatting.  If you don't see colored form fields when you open a document, go to Adobe/Preferences/Forms, and click the box to show the form fields in color.

If you can't get the pdf forms to work, you may need to download a newer version of the Adobe Reader. (The latest version is 8.0.) You may download the Reader for free at www.adobe.com. 

Accident Report Forms

Section 6(b) of the Workers' Compensation Act requires employers (or insurers acting on their behalf) to send reports to the Commission on all accidents involving more than three lost work days. First reports on fatal accidents are due within two work days after the death; reports on nonfatal cases shall be reported within the month.  A supplementary or subsequent report should be made if it is determined that a permanent disability is involved. 

There are two versions of each report below.  We will accept either version.   The IC45 and IC85 forms were created by the Commission; the IA1 and IA2 forms were created by the International Association of Industrial Accident Boards and Commissions, and are used in several states. It may be more convenient for multi-state employers to use the IAIABC forms.

OSHA will accept the IC45 or the IA-1 form in lieu of the OSHA Form 301; however, we cannot accept the OSHA form as an accident report because the OSHA form does not contain all the information required by state law.

If possible, please send the reports electronically.  It reduces our data-entry work considerably, and will save you paper and postage. For an information packet on electronic transmission, click here.  For more technical information, contact Bennie Horton, Jr. (312/814-6179).

Please mail the hard-copy accident reports to 701 S. Second Street, Springfield, IL 62704.

To modify the Word forms, go to Tools/Unprotect Document; type in the password "iwcc" in lower case. 

Arbitration Decision Forms

To make a check mark, click your cursor in the box. In the Findings section, on several occasions, a drop-down box will ask you to choose a selection (e.g, "$250,000 or 20 years" v. "$500,000 or 25 years"); click on the arrow to make your selection.

To modify the Word forms, go to Tools/Unprotect Document; type in the password "iwcc" in lower case. 

Assessment Forms
are on the Assessments web page.

Case Management Forms

To modify the Word forms, go to Tools/Unprotect Document; type in the password "iwcc" in lower case. 

Self-Insurance Forms

An Application for Self-Insurance should be received at least 60 days prior to the requested effective date of self-insurance. Please make sure you submit all necessary materials with your application. Remember you must keep your regular insurance coverage until you receive written confirmation from the Commission authorizing you for the self-insurance privilege. We will make every effort to process applications promptly.

To modify the Word forms, go to Tools/Unprotect Document; type in the password "iwcc" in lower case. 

Other Forms

To modify the Word forms, go to Tools/Unprotect Document; type in the password "iwcc" in lower case. 

Let us know if there is something we can do to the forms to make them more convenient for you to use. But before you write about formatting questions, please read the directions on this page.