Michigan workers comp form 2026

1. Click ‘Get Form’ to open the Michigan Workers Comp Form in our editor.
2. Begin by filling out the Employee Data section. Enter the employee's Social Security Number, date of injury, full name, address, date of birth, sex, number of dependents, and telephone number.
3. Next, move to the Employer/Carrier Data section. Provide the employer's name, Federal ID Number, mailing location code, and insurance company details if applicable.
4. In the Injury/Medical Data section, detail the last day worked and any medical treatment received. Be specific about how the injury occurred and what part of the body was affected.
5. Complete the Occupation and Wage Data section by entering the date hired, total gross weekly wage, occupation specifics, and any relevant volunteer or vocational handicap status.
6. Finally, fill out the Preparer Data section with your name, signature, contact number, and date prepared. Ensure all information is accurate before submitting.

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