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Alaska Department of Labor and Workforce Development Forms

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Form FI-41 Vessel Owner (Employer) - Crewman Agreement Regarding Medical and Related Transportation or Other Expenses - Alaska PDF

Form FI-41 Vessel Owner (Employer) - Crewman Agreement Regarding Medical and Related Transportation or Other Expenses - Alaska
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Form TQ01C Alaska Quarterly Contribution Report - Alaska, 2023 PDF

Form TQ01C Alaska Quarterly Contribution Report - Alaska, 2023
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Form TQ01C Alaska Quarterly Contribution Report - Alaska, 2022 PDF

Form TQ01C Alaska Quarterly Contribution Report - Alaska, 2022
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Form TQ01A Alaska Quarterly Contribution Report Change Notification Sheet - Alaska PDF

Form TQ01A Alaska Quarterly Contribution Report Change Notification Sheet - Alaska
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Instructions for Form TQ01C Alaska Quarterly Contribution Report - Alaska PDF

Instructions for Form TQ01C Alaska Quarterly Contribution Report - Alaska
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Instructions for Form TQ01B, TQ01C Alaska Quarterly Contribution Report - Alaska PDF

Instructions for Form TQ01B, TQ01C Alaska Quarterly Contribution Report - Alaska
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Form TADJ Correction of Wage Items - Alaska PDF

Form TADJ Correction of Wage Items - Alaska
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Form TSUP Supplemental Alaska Quarterly Form - Alaska PDF

Form TSUP Supplemental Alaska Quarterly Form - Alaska
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Form TREG Alaska Employer Registration Form - Alaska PDF

Form TREG Alaska Employer Registration Form - Alaska
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Form TREG Alaska Employer Registration Form - Alaska PDF

Form TREG Alaska Employer Registration Form - Alaska
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Form TREG Voluntary Election of Coverage for Excluded Employment - Alaska PDF

Form TREG Voluntary Election of Coverage for Excluded Employment - Alaska
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Form 07-1466 Employee Application for Refund - Alaska PDF

Form 07-1466 Employee Application for Refund - Alaska
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Form 07-6119 Fishermen's Fund Report of Vessel/Site Insurance - Alaska PDF

Form 07-6119 Fishermen's Fund Report of Vessel/Site Insurance - Alaska
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Form 07-6153 Reemployment, Election to Either Receive Reemployment Benefits or Waive Reemployment Benefits and Receive a Job Dislocation Benefit Instead - Alaska PDF

Form 07-6153 Reemployment, Election to Either Receive Reemployment Benefits or Waive Reemployment Benefits and Receive a Job Dislocation Benefit Instead - Alaska
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Form 07-6138 Change of Address - Alaska PDF

Form 07-6138 Change of Address - Alaska
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Form 07-6130 Renewal of Certificate of Self-insurance - Alaska PDF

Form 07-6130 Renewal of Certificate of Self-insurance - Alaska
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Form 07-6121 Request for Release of Information - Alaska PDF

Form 07-6121 Request for Release of Information - Alaska
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Form 07-6131 Petition for Executive Officer Waiver - Alaska PDF

Form 07-6131 Petition for Executive Officer Waiver - Alaska
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Form 08-6106 Claim for Workers' Compensation Benefits - Alaska PDF

Form 08-6106 Claim for Workers' Compensation Benefits - Alaska
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Form 07-6111 Petition - Alaska PDF

Form 07-6111 Petition - Alaska
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Form 07-6170 Employer's Notice of 45 Consecutive Days of Time Loss for Injuries - Alaska PDF

Form 07-6170 Employer's Notice of 45 Consecutive Days of Time Loss for Injuries - Alaska
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Form 07-6169 Employer's Notice of 90 Consecutive Days of Time Loss for Injuries - Alaska PDF

Form 07-6169 Employer's Notice of 90 Consecutive Days of Time Loss for Injuries - Alaska
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Form 07-6152 Stipulation to Eligibility for Injuries - Alaska PDF

Form 07-6152 Stipulation to Eligibility for Injuries - Alaska
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Form 07-6166 Application to Provide Reemployment Services as a Rehabilitation Specialist Under as 23.30.041 - Alaska PDF

Form 07-6166 Application to Provide Reemployment Services as a Rehabilitation Specialist Under as 23.30.041 - Alaska
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Form 07-6124 Commercial Fishermen's Fund Compelling Reasons Questionnaire - Alaska PDF

Form 07-6124 Commercial Fishermen's Fund Compelling Reasons Questionnaire - Alaska
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Form 07-6058 BI-Weekly Certified Payroll - Alaska PDF

Form 07-6058 BI-Weekly Certified Payroll - Alaska
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Form 07-6151 Offer of Alternative Employment - Alaska PDF

Form 07-6151 Offer of Alternative Employment - Alaska
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Form 07-6171 Reemployment Benefits Plan Checklist - Alaska PDF

Form 07-6171 Reemployment Benefits Plan Checklist - Alaska
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Form 07-6168 Waiver of Reemployment Benefits - Alaska PDF

Form 07-6168 Waiver of Reemployment Benefits - Alaska
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Form 07-6150 Eligibility Evaluation Checklist - Alaska PDF

Form 07-6150 Eligibility Evaluation Checklist - Alaska
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Form 07-6110 Notice of Possible Claim Against the Second Injury Fund - Alaska PDF

Form 07-6110 Notice of Possible Claim Against the Second Injury Fund - Alaska
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Form 07-6103 Workers' Compensation Medical Summary - Alaska PDF

Form 07-6103 Workers' Compensation Medical Summary - Alaska
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Form 07-6120 Employer's Notice of Insurance - Alaska PDF

Form 07-6120 Employer's Notice of Insurance - Alaska
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Form 07-6122 Public Records Request - Alaska PDF

Form 07-6122 Public Records Request - Alaska
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Form 07-6135 Request for Conference - Alaska PDF

Form 07-6135 Request for Conference - Alaska
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Form 07-6148 Affidavit Verifying Sime Records Are Complete - Alaska PDF

Form 07-6148 Affidavit Verifying Sime Records Are Complete - Alaska
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Form 07-6112 Subpoena - Alaska PDF

Form 07-6112 Subpoena - Alaska
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Form 07-6107 Affidavit of Readiness for Hearing - Alaska PDF

Form 07-6107 Affidavit of Readiness for Hearing - Alaska
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Form 07-6116 Notice of Appearance - Alaska PDF

Form 07-6116 Notice of Appearance - Alaska
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Form 07-6114 Notice of Intent to Rely - Alaska PDF

Form 07-6114 Notice of Intent to Rely - Alaska
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