Forms & Documents Building a Small Business Operational Safety Plan Employee Certificate of Compliance (Form LWC-WC-2025.EE) First Report of Injury (State WC) First Report of Injury (Longshore) Injured Worker First Fill Prescription Form (in English) Injured Worker First Fill Prescription Form (en Español) Interactive Registration Form—Agents Interactive Registration Form—Policyholders Notice of Compliance Regarding La. Workers’ Compensation Law (in English) Notice of Compliance Regarding La. Workers’ Compensation Law (en Español) OMNET Statewide Managing Care Provider List Overtime Defined Physician Choice (Form LWC–WC 1121) Sample Drug-Free Workplace Policy (in English) Sample Drug-Free Workplace Policy (en Español) Sample Seatbelt Policy Second Injury Fund Medical History Questionnaire (in English) Second Injury Fund Medical History Questionnaire (en Español) Return to Work Sample Return-to-Work Documents (English) Sample Company Return-to-Work Policy Sample Employee Job Description Sample Physician Return-to-Work Letter Sample Post-Injury Return-to-Work Checklist Sample Transitional Duty Offer Sample Transitional Duty Offer Letter Sample Return-to-Work Documents (Spanish) Norma de Regreso al Trabajo de la Compañia Descripcion del Trabajo del Empleado Carta al Medico para el Regreso al Trabajo Lista de Revision para el Regreso al Trabajo Despues de un Accidente Ofrecimiento Transitorio de Trabajo Carta de Oferta de Trabajo Transitorio al Empleado Policyholder Resources Audit Dispute Form Certificates of Insurance Claims Management Claims Value-Added Services Fraud Reporting Legal Services Longshore & Maritime Guide (2018–2019) LWCC at a Glance Medicare Secondary Payer Mandatory Reporting Premium Audit Reporting Purposes Only (RPO) Program Safety Services