PDF
Word
Form ICA6611 Self-insured Injury Report - Arizona
What Is Form ICA6611?
This is a legal form that was released by the Industrial Commission of Arizona - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form ICA6611?A: Form ICA6611 is a self-insured injury report specifically for the state of Arizona.
Q: Who needs to fill out Form ICA6611?A: Employers who are self-insured in Arizona need to fill out Form ICA6611 for reporting workplace injuries.
Q: What is the purpose of Form ICA6611?A: The purpose of Form ICA6611 is to report workplace injuries that occur to self-insured employers in Arizona to the Industrial Commission of Arizona.
Q: What information is required on Form ICA6611?A: Form ICA6611 requires information such as employee details, injury details, medical treatment information, and insurance information.
Form Details:
- Released on December 5, 2020;
- The latest edition provided by the Industrial Commission of Arizona;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form ICA6611 by clicking the link below or browse more documents and templates provided by the Industrial Commission of Arizona.
