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An Official Vermont Government Website

Injured Workers' Forms

Form 05
EMPLOYEE’S NOTICE OF INJURY AND CLAIM FOR COMPENSATION
FORM 5
Form 06
NOTICE AND APPLICATION FOR HEARING
FORM 6
Form 08
NOTICE OF INTENT TO CHANGE HEALTH CARE PROVIDER
FORM 8
Form 7
VT Medical Authorization Form
FORM 7
Form VR 08
Form VR 8-NOTICE OF INTENT TO CHANGE VOCATIONAL REHABILITATION PROVIDER
FORM VR 8
Printable Job Search Fill-in Logs
Complete your Job Search Logs
Job Search Fill-in Logs
Mileage Reimbursement Request Form
Keep Track and submit your mileage reimbursement
Mileage Reimbursement Req