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Forms

​Authorization To Release Information.pdf Download
​Company Nurse Wallet Card Template.pdf Download​
​Company Nurse First Report Poster Template.pdf ​​Download
​Employee Injury of Illness Notification.pdf Download​​
​Employer Investigation Report.pdf Download
​Mileage Form.pdf ​Download​
Patient Status Report.pdf ​Download​
​Wage Statement.pdf Download​​

Model Programs are found in the Loss Control section of this site.

Templates for Company Nurse Wallet Cards and Posters are available for download or contact imwcainfo@iowaleague.org​ to have IWMCA print these for you.

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Contact Information

Phone: (800) 257-2708
Fax: (978) 367-2862
imwcainfo@iowaleague.org
Administered by the Iowa League of Cities