Form 5 – Employee’s Notice of Injury and Claim for Compensation – Rev 9-11 | Department of Labor

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Workers' Comp Forms

Form 5 – Employee’s Notice of Injury and Claim for Compensation – Rev 9-11

Friday, May 24, 2019

File:

Form 5 – Employee’s Notice of Injury and Claim for Compensation

File Format:

PDF

Contact Information

COVID-19 Update: Department of Labor offices are currently closed due to COVID-19. Please contact the Department by phone.

Vermont Department of Labor
5 Green Mountain Drive
P.O. Box 488
Montpelier, 05601-0488
(802) 828-4000

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