Forms

Child Labor/ Minor's Work Permit

• CL-1
  Child Labor Application (for 14 and 15-year-old minors)
• eCL-3
  Online Child Labor Application (for 16 and 17-year-old workers)

• HFLL-1
  An optional form for the certification of a serious health condition by a health care provider

Employer Forms

• BB-1
  Basic Business Application
• DC-1
  Summary of Workers' Compensation, Temporary Disability Insurance and Prepaid Healthcare Laws
• LIR#27
  Application for Certificate of Compliance with Section 3-122-112, HAR
• UC-25
  Notification of Changes
• UC-86
  Waiver of Employer's Experience Record
• *UC-B6
  Quarterly Wage, Contribution and Employment and Training Assessment Report
  (*Not available online - for assistance, please call 586-8915 or 586-8916)

Family Leave

• HFLL-1
  An optional form for the certification of a serious health condition by a health care provider

Hawaii Labor and Industrial Relations Appeals Board

• Revised initial conference statement

Hawaii Labor Relations Board

• HLRB 1
  Petition for Certification
• HLRB 2
  Petition for Clarification or Amendment of Appropriate Bargaining Unit
• HLRB 3
  Petition for Decertification
• HLRB 4
  Prohibited Practice Complaint
• HLRB 5
  Petition for Review of Refunds
• HLRB 6
  Statement of Objections to Conduct of Election
• HLRB 7
  Petition Relating to Financial Report of Employee Organization
• HLRB 8
  Petition for Determination of CB Unit and Election
• HLRB 9
  Petition for Referendum
• HLRB 10
  Petition for Decertification
• HLRB 11
  Unfair Labor Practice Complaint
• HLRB 12
  Petition for Declaratory Ruling
• HLRB 13
  Petition for Intervention
• HLRB 14
  Application for Issuance of Subpoenas
• HLRB 15
  Subpoena
• HLRB 16
  Subpoena Duces Tecum
• HLRB 17
  Sample Format for HIOSH Initial Conference Statement

Hawaii Occupational Safety & Health

• Advisory Board

  • Application Form

• Boilers & Elevators

  • Authorization for Repair/Alteration Application
  • Certificate of Competency Application
  • Elevator Inspection Request Form
  • Installation Permit Application
    • Boiler
    • Elevator
  • Non-Boiler External Piping (NBEP)
    • Certificate of Authorization to Fabricate/Repair Application
    • Repair/Installation Application
  • Notification of Sale or Relocation of a Boiler or Pressure Vessel
  • Personnel Hoist Installation Permit Application
• Certificate of Fitness for Explosives
  • Certificate of Fitness Application
  • Application Procedures
  • Criminal background check
• Certified Safety and Health Professional
  • CSHP Application
  • Experience Form
  • Reference Questionnaire Form
• Hoisting Machine Operators Advisory Board
• Application for Certification
• Application for Special Certification
• Library
  • HIOSH Library Borrowing Agreement Form
  • AV Materials Request Form

Hawaii Civil Rights Comission

• FORM PCQ-Employment: Pre-Complaint Questionnaire Employment
• FORM PCQ-Access to State/Funded Services: Pre-Complaint Questionnaire
• FORM PCQ-Public Accommodation: Pre-Complaint Questionnaire
• FORM PCQ-Real Property Transaction: Pre-Complaint Questionnaire

Prepaid Healthcare

• HC-4
  Health Care Coverage Questionnaire
• HC-5 2007 | 2008
  Employee Notification to Employer
• HC-6
  Small Employers Subject To PHC / Employer's Request for Premium Supplementation
• HC-61
  Application For Self-Insurance Authorization

State Fire Council

• SFC 1-99
  Fire Inspection Report

Temporary Disability Insurance

• TDI-13
  Application For TDI Self-Insurance
• TDI-14
  Equivalency Tables
• TDI-15
  TDI Self-Insurer's Plan Certification & Agreement

Unemployment Insurance

Employers

• LIR#27
  Application for Certificate of Compliance with Section 3-122-112, HAR (Use this form to request a tax clearance from the Department of Labor & Industrial Relations for Professional Service Awards)
• BB-1
  Basic Business Application (Use this form to register your business with the Unemployment Insurance Division when employment commences)
• *UC-B6
  Quarterly Wage, Contribution and Employment and Training Assessment Report
  (*Not available online - for assistance, please call 586-8915 or 586-8916)
• UC-25
  Notification of Changes (Use this form to notify the Unemployment Insurance Division of any changes to an employer's address or status of business)
• UC-336
  Election By Family Owned Corporation to be Excluded from coverage Under Section 383-7(20), HRS (Use this form to elect exclusion from unemployment insurance coverage of a family-owned corporation)
• UC-86
  Waiver of Employer's Experience Record (Use this form to request acquisition of the experience record of a predecessor employer)

UI Claimants

• UC-253
  Record of Contacts Made for Work
  

Workers' Compensation

• WC-1
  Employer's Report of Industrial Injury
• WC-2
  Physician's Report
• WC-5
  Employee's Claim for Workers' Compensation Benefits
• WC-5A
  Dependents' Claim for Compensation
• WC-14
  Employee's Wage Report
• WC-21
  Application for Self-Insurance Authorization
• WC-77
  Application for Hearing
• WC-77a
  Response to Application for Hearing
• LIR#27
  Application for Certificate of Compliance with Section 3-122-112, HAR

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