Colorado > Workers Comp
Monthly Summary WC98 - Colorado
| Monthly Summary Form. This is a Colorado form and can be used in Workers Comp . |
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DEPARTMENT OF LABOR AND EMPLOYMENT Division of Workers' Compensation Research and Statistics Unit 633 17th Street, Suite 400 Denver, CO 80202-3626 MONTHLY SUMMARY Date Completed ___________________________ Carrier Number ______________________________ Carrier Name __________________________________________________________________________ Summary of injuries reported pursuant to Section 8 -43-101(2) C.R.S. as amended. Total number of medical-only cases accepted for payment (no lost time in excess of 3 days, etc.) including occupational disease not listed Rule 5-2(B). 1 Total number of exposures to injurious substances Totals January February March April May June July August September October November December 1 List of exposures to injurious substances: ___________________________________________________________ _______________________________________________________________________________________________ Remarks: _______________________________________________________________________________________ ______________________________________________________________________________________ Contact: Address: WC098 Rev 01/06 American LegalNet, Inc. www.FormsWorkFlow.com
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