Form Dwc-01 - Employer'S First Report Of Alleged Occupational Injury, Disease Or Fatality Page 2

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State of Rhode Island
Department of Labor and Training
Division of Workers' Compensation
1511 Pontiac Avenue
Cranston, RI 02920
Forms Revised January, 2003
Form
Form Title
Number
Employee's Certificate of Dependency Status
DWC-04
Employee's Objection to Wage Transcript
DWC-31
Employer's First Report of Alleged Occupational Injury or Disease
DWC-01
Itemized Statement of Compensation
DWC-50
Memorandum of Agreement
DWC-02
Mutual Agreement
DWC-24
Non-Prejudicial Agreement
DWC-20
Notice to Employees
DWC-32
Report of Earnings
DWC-25
Report of Indemnity Payment
DWC-22
Report of Specific Payment
DWC-51
Suspension Agreement and Receipt
DWC-05
Wage Statement, Full-Time
DWC-03F
Wage Statement, Part-Time
DWC-03P
Wage Statement, Seasonal
DWC-03S
Wage Transcript
DWC-30

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