Forms

Applications

• Dairy
• Feedlot
• Aviation

Accidents

• Accident Flow Chart
• Near Miss Information
• Information for Injured Employees – English (K-WC 27)
• Information for Injured Employees – Spanish (K-WC 270)

Contractors

Every independent, self-employed contractor should provide the employer with a completed and signed affidavit found at this link (from ksinsurance.org):

• Affidavit of Exempt Status – Fillable English pdf
• Affidavit of Exempt Status – Fillable Spanish pdf

Postings

These forms must be posted and maintained by the employer in one or more conspicuous places:

• Workers Compensation Rights & Responsibilities – K-WC 40 Form
• Injury & Illness Forms – OSHA 300 Forms

Employers & Employees

• Notice Requirements for Work Related Injury – English – Spanish
• KDOL Workcomp Handbook – K-WC-25 – English – Spanish
• Opt-In (Accept) Coverage – K-WC 113
• Opt-Out (NOT Accept) Coverage – K-WC 50