2nd Injury Fund Forms
2013 Assessment
Please select the appropriate form below.
2012 Assessment
- 2012 2nd Injury Recommendation Report
- 2012 Certificate
Please select the appropriate form below.
2011 Assessment
- 2011 2nd Injury Recommendation Report
- 2011 Certificate
Please select the appropriate form below.
2010 Assessment
- 2010 2nd Injury Recommendation Report
- 2010 Certificate
Please select the appropriate form below.
2009 Assessment
- 2009 2nd Injury Recommendation Report and Assessment
- 2009 Certificate
Please select the appropriate form below.
2008 Assessment
- 2008 2nd Injury Recommendation Report and Assessment
- 2008 Certificate
Please select the appropriate form below.
2007 Assessment
- 2007 2nd Injury Recommendation Report and Assessment
- 2007 Certificate
Because the assessment calculations differ between carriers and self-insured employers, we have created a unique certification form for each. Please select the appropriate form below.
2006 Assessment
- 2006 2nd Injury Recommendation Report
- 2006 Assessment
- 2006 Certificate
2005 Assessment
- 2005 2nd Injury Recommendation Report
- 2005 Assessment
- 2005 Certificate
2004 Assessment
- 2004 2nd Injury Recommendation Report
- 2004 Assessment
- 2004 Certificate
2003 Assessment
- 2003 2nd Injury Recommendation Report
- 2003 Assessment
- 2003 Certificate
- Second Injury Fund Acturial
Injured Employee Assistance
Prosthetic Applications
Past Years Assessment Information
- 2002 2nd Injury Recommendation
- 2002 2nd Injury Notice of Assessment
- 2002 2nd Injury Certificate
- 2001 2nd Injury Recommendation
- 2001 2nd Injury Notice of Assessment
- 2001 2nd Injury Certificate
- 2000 2nd Injury Recommendation
- 2000 2nd Injury Notice of Assessment
- 2000 2nd Injury Certificate
- 1999 2nd Injury Recommendation
- 1999 Assessment Notice
- 1999 Assessment Notice - Addendum
- 1999 2nd Injury Certificate
