Legal Forms >> Michigan >> Workers' Compensation
Form #:MI-WC-0117 This form is used by an employee who has been injured on the job to report the extent of his or her injury and the nature of the injury, as well as indicate whether or not he or she has returned to work. A medical report, if available, should be included.
Name:Employee's Report of Claim Form Number: MI-WC-0117 State:Michigan Statute: Form Category:Workers' Compensation
This form is only available as a downloadable PDF which will be made available to you after you complete your purchase.
Search MillerDavis.com for legal forms and specialty products.
All of our forms include standard shipping at no additional cost.