Download FAX Forms

If there were few or no work-related injuries and illnesses at your sampled establishment in calendar year 2008, you may respond to us via FAX. You may select a form below based on the location of your establishment.

State Code State Name FAX Form
01 Alabama AL_2008.PDF
02 Alaska AK_2008.PDF
04 Arizona AZ_2008.PDF
05 Arkansas AR_2008.PDF
06 California CA_2008.PDF
08 Colorado CO_2008.PDF
09 Connecticut CT_2008.PDF
10 Delaware DE_2008.PDF
11 District of Columbia DC_2008.PDF
12 Florida FL_2008.PDF
13 Georgia GA_2008.PDF
66 Guam GU_2008.PDF
15 Hawaii HI_2008.PDF
16 Idaho ID_2008.PDF
17 Illinois IL_2008.PDF
18 Indiana IN_2008.PDF
19 Iowa IA_2008.PDF
20 Kansas KS_2008.PDF
21 Kentucky KY_2008.PDF
22 Louisiana LA_2008.PDF
23 Maine ME_2008.PDF
24 Maryland MD_2008.PDF
25 Massachusetts MA_2008.PDF
26 Michigan MI_2008.PDF
27 Minnesota MN_2008.PDF
28 Mississippi MS_2008.PDF
29 Missouri MO_2008.PDF
30 Montana MT_2008.PDF
31 Nebraska NE_2008.PDF
32 Nevada NV_2008.PDF
33 New Hampshire NH_2008.PDF
34 New Jersey NJ_2008.PDF
35 New Mexico NM_2008.PDF
36 New York NY_2008.PDF
37 North Carolina NC_2008.PDF
38 North Dakota ND_2008.PDF
39 Ohio OH_2008.PDF
40 Oklahoma OK_2008.PDF
41 Oregon OR_2008.PDF
42 Pennsylvania PA_2008.PDF
43 Puerto Rico PR_2008.PDF
44 Rhode Island RI_2008.PDF
45 South Carolina SC_2008.PDF
46 South Dakota SD_2008.PDF
47 Tennessee TN_2008.PDF
48 Texas TX_2008.PDF
49 Utah UT_2008.PDF
50 Vermont VT_2008.PDF
51 Virginia VA_2008.PDF
52 Virgin Islands VI_2008.PDF
53 Washington WA_2008.PDF
54 West Virginia WV_2008.PDF
55 Wisconsin WI_2008.PDF
56 Wyoming WY_2008.PDF

 

Last Modified Date: January 14, 2009