Workers Compensation Claim Forms

All forms should be completed and submitted immediately or no later than 24-hours of an incident or 8-hours if employee is hospitalized.   

Fax forms for claims to (907) 714-2384 or email to skisena@kpb.us

 If you have questions or need assistance with the forms, please call the Risk Manager at (907) 714-2351 or the Safety Manager at (907) 714-2354

Workers' Compensation Forms and Reporting

Employee Report of Occupational Injury or Illness to Employer

Drivers Report of An Accident

Supervisor Report of Employee Injury 

 Incident Reporting and Investigation Form