Embedded Files
UTAH
SLC - ACCIDENT/INCIDENT - IN STORE (This form is for internal notification only - if applicable, complete an injury claim below)
SLC - ACCIDENT - MOTOR VEHICLE (This form is for internal notification only - complete an auto claim form below to notify our insurance carreir)
HAWAII
HAWAII - ACCIDENT/INCIDENT - IN STORE (This form is for internal notification only - if applicable, complete an injury claim below)
HAWAII - ACCIDENT - MOTOR VEHICLE (This form is for internal notification only - complete an auto claim form below to notify our insurance carreir)
Utah FNOI.pdfUTAH WORKERS COMP CLAIM FORM
Click on the form and download it. Complete the form, scan it and send it back to wcclaims@leelynhr.com Attn: Shannon Brewer or Chris Kenny
Hawaii FNOI.pdfHAWAII WORKERS COMP CLAIM FORM
Click on the form and download it. Complete the form, scan it and email it back to wcclaims@leelynhr.com Attn: Shannon Brewer or Chris Kenny
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