SCF ARIZONA

Information & Forms

You can download many of SCF Arizona’s safety brochures, policy pamphlets, posters, annual reports and forms policyholders and injured workers need.

To apply for workers’ compensation insurance from SCF Arizona, get a quote online or call 602.631.2600. If the form you need is not available below, fill out a contact us form or give us a call. Our Customer Contact Center is ready to serve you from 8 a.m. to 5 p.m., Monday through Friday.

Download form to order workplace safety materials.

Forms

• Employer’s Report of Industrial Injury (Form 101)
• Instructions for Completion of Employer’s Report of Injury (Form 101i)

POLICY

• Policyholder Change of Address (61-301)

• Change in liability limits (61-818)

• Third-party representative (61-817)

• Application for sole proprietor or single-member coverage (61-041)

• Application for partnership coverage (61-040)

• Sole proprietor waiver/Single member LLC waiver (61-511)

• Business name or entity change form (61-201)

• Policyholder Audit Dispute Request Form (71-002)

• Association Safety Program Application (81-337) For more information on the program, please read the brochure.

CLAIMS

• 41-110a - Worker’s Annual Report of Income

• 41-120 - Attending Dentist Estimate and Billing Statement
• 41-407 - Workers’ Report of Injury

• 41-467 - Claimant Change of Address
• 41-489 - Unpaid Bill Inquiry
• 61-261 - Report of Significant Work Exposure to Bodily Fluids
• First-fill prescription form

Safety Materials

• Download form to order workplace safety materials.

• Need safety training videos? Borrow from SCF Arizona's library of videos on various safety topics. Download form

• Looking for the 'Little Blue Book' or the 'Little Green Book'? The Supervisor's Report of Injury (64-100 and 64-100S), is not downloadable. Please use our order form.

POSTERS

These posters are required to be displayed on a worksite.
AZ Workers’ Compensation Law (the red poster)
Work Exposure to Bodily Fluids (the blue poster)

Work Exposure to Bodily Fluids (Spanish)

*New* Work Exposure to MRSA, Spinal Meningitis, or TB (the yellow poster)

BROCHURES

*New* How to File Your Payroll Report (step-by-step document)

*New* Return to Work / Stay at Work Guide

*New* Sample Return to Work forms for employers

*New* Sample Return to Work forms - en español
Early Return to Work

13 steps in Controlling Your Workers' Comp Costs
Association Safety Program (#81-1007)
Benefits Guide

Employer's Guide to Workers’ Compensation
Report an Injury
81-1010 - You and the PCN for policyholders

81-1011 - You and the PCN for Medical Providers
You and Your E-mod

Your Payroll Report (explanatory brochure)

Managing Claims - this brochure is being updated and will be available soon for download

PAMPHLETS