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Industrial Injury Forms & County Claim Documents

These documents are formatted in Microsoft Word. Accessing any of these forms will open a new window. The forms are designed for the reader to enter limited information. Please note that when the cursor is placed into a writable field, there is a note at the bottom of the screen that will indicate the maximum number of characters that may be entered. You will not be allowed to enter more characters even if you create more space using the 'enter' key.

After completing your entries, you can either print the document or save it to a designated drive on your computer. You will also receive a prompt regarding saving or discarding the changed form if you close the window after entering any information.

These forms are only for the Maricopa County Government and it's employees.
All others Click "HERE" for the Notice of Claim Form.

Safety Reporting Forms

For information regarding Workers' Compensation, please click "HERE"

For a list of Concentra locations, please click "HERE"

County Claim Documents
Vehicle Use Permit Forms
Job Safety Analysis (JSA)

The following information is nonproprietary can be used by anyone.

Job Safety Analysis (JSA) is a method that can be used to identify, analyze and record:

  • The steps involved in performing a specific job.
  • The existing or potential safety and health hazards associated with each step.
  • The recommended action(s)/procedure(s) that will eliminate or reduce these hazards and the risk of a workplace injury or illness.
Use the following link for more information.

Updated 18 Nov 2011, jld

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