CURRENT COURT FORMS
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The following Forms Table provides you easy
access to the most current revision of the Court's forms. You may
open the blank form by clicking on the 'PDF' link on the right-side
of
the
associated Form. Fill out the form, and print the desired number of
copies to your local printer for use in submitting to the Court and
maintain copies for your records. As part of the function of Adobe
Acrobat Reader, the program does allow users to fill-in a form
and save the document to your local system.
A supply of blank forms may be printed by
users from this Forms Table using the color paper as denoted by the
color reference on this table.
| Form No. | Title | Form Color | File |
|---|---|---|---|
| 1A | Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees. Superseded by CC-Form-1A (external link to Workers' Compensation Commission website) | ||
| 1A | Aviso E Instrucción de Compensación de Trabajadores de Oklahoma para Empresarios Y Trabajadores. Superseded by CC-Form-1A-Spanish (external link to Workers' Compensation Commission website) | ||
| 1B | Employers Application for Permission to Carry Its Own Risk Without Insurance. Superseded by FORM-SI-EMPLOYER (External link to Workers' Compensation Commission website) | ||
| CS-APPENDIX | Compromise Settlement Appendix 6/15 | ||
| CCS | Certificate to Compromise Settlement. 2/14 | ||
| CSD-337 | Compromise Settlement. (Death Claim) 6/15 | ||
| CS-339A | Compromise Settlement. 6/15 | ||
| CS-339B | Compromise Settlement - Agreement Between Employer and Employee as to Fact with Relation to an Injury and Payment of Compensation. 6/15 | ||
| 2 |
Employer's First Notice of Injury. 6/15 (To be used for injuries prior to 02/01/2014) |
||
| 3 | Employee's First Notice of Accidental Injury and Claim for Compensation. 6/15 | Yellow | |
| 3A | Claimant's First Notice of Death and Claim for Compensation. 6/15 | Gold | |
| 3B | Employee's First Notice of Occupational Disease and Claim for Compensation. 6/15 | Gray | |
| 3E | Employee's Claim For Benefits For Combined Disabilities Against the Last Employer. 6/15 | ||
| 3F | Employee's Notice of Claim for Benefits From Multiple Injury Trust Fund. 6/15 | Tan | |
| 4 | Treating Physician's Report and Notice of Treatment. 6/15 | ||
| 5 | Physician's Report on Release and Restrictions. 6/15 | ||
| 9 | Motion to Set for Trial. 6/15 | ||
| 10 | Answer and Pretrial Stipulation Offered by Respondent. 6/15 | Green | |
| 10A | Respondent's Response to Claimant's Form-A Application For Change of Physician. 6/15 | Blue | |
| 10M | Response to Request for Payment of Charges for Medical or Rehabilitation Services. 6/15 | Ivory | |
| 13 | Request for Prehearing Conference. 6/15 | ||
| 18 | Request For Court Administrator Review of Disputed Medical Charges. 6/15 | Orchid | |
| 19 | Request for Payment of Charges for Health or Rehabilitation Services/ Notice of Appeal of Court Administrator Order. 2/14 | ||
| 20 | Proof of Loss (Death Claim). 2/14 | Blue | |
| 926 | Application for Appointment as Certified Workers' Compensation Mediator. 6/15 | ||
| 93 | Application and Order for Leave to Withdraw as Attorney of Record. 6/15 | ||
| 99 | Pauper's Affidavit. 6/15 (two-sided form) | ||
| 100 | Claimant's Application and Order for Dismissal. 6/15 | ||
| A | Claimant's Application for Change of Physician and Request for Hearing. 6/15 | ||
| A - Order | Order for Change of Treating Physician. 6/15 | ||
| NPT | Request for Nunc Pro Tunc 2/14 | ||
| Copy Request Form. 6/15 | |||
| Vendor Maintenance Form 08/10 | |||
| IME - Order | Order for Appointment of Independent Medical Examination | ||
| Trial / PHC Form Order and Instruction for filling out Form. | |||
| Prior Claims Request Form and instruction for filling out Request Form. | |||
| Subpoena Duces Tecum (for the production of documents) | |||
| Subpoena (for appearance) | |||
| Requisition for Workers' Compensation File - Exempt Requestor | |||
| COPIER CHARGE ACCOUNT MAINTENANCE FORM |
