Anyone not a state employee trying to file a claim, please contact a claims administrator at 465-2180.
Report of Occupational Injury or Illness
Please note, the process for reporting an injury or illness changed in July 2013. Both of the following forms must be completed for Workers' Compensation.
- Employee Report to Employer - Form 07-6100 (word)
- Employer Report to Division of Workers' Compensation - Form 07-6101 (word)
- Example - Form 07-6101 (pdf)
- Third-Party Claims Administrator:
Penser North America Inc.
PO Box 241148
Anchorage, AK 99524
Toll Free: 1-844-463-2727
Liability Accident Notice
Please note, the form is in Microsoft Word format. When following the link, you may need to select "Save" or "Save As..." in order to save the document to your computer prior to editing.
Liability Accident Report (word)
In Internet Explorer, you will be prompted whether to Open or Save the document.
Please choose Save.
Once you have saved it to your computer, you will be able to edit and print it.
If you would rather print the form and fill it out by hand, you may use the PDF version of the same document: Liability Accident Report (PDF).
Other Common Forms
- Division of Marine Highways Accident/Illness Report (PDF)
- Employee's/Master Report of Maritime Injury or Illness (PDF)
- AMHS Vehicle Accident/Property Damage Report (PDF)
- AMHS Vehicle Accident/Property Damage Report Instructions (PDF)
- Pilot Qualification Certification (PDF)
- Supervisor Accident Investigation Report (PDF)
- Volunteer Accident Report (PDF)
- Volunteer Service Agreement (PDF)
You must be inside the state network to access these forms.
All files are in either Word or Adobe PDF format. If you are having difficulty opening them, please email the webmaster.