Get your free Adobe® Acrobat® Reader now!Due to popular demand, the N.C. Industrial Commission has created a Microsoft® Word document template for Form 19—Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission (revised 8/6/08). (Warning: If there is an Enter Network Password popup when you click the preceding hypertext link, click Cancel to complete the downloading process.)
After you download this file and install it in your document template directory, you may open a new document based on this template by opening Microsoft® Word, going to the Menu Bar, selecting File, choosing New, and then double-clicking on the Form19 icon.
| NOTE: You may modify FORM19.DOT to include the employer’s name, address, telephone number, etc., by opening the template in Microsoft® Word, choosing Tools from the Menu Bar, selecting the Unprotect Document option, and filling in the appropriate blanks. Afterwards, you must select Tools, choose Protect Document, click Forms:, click OK, and then save (Ctrl S) the template. |
The Industrial Commission requires that all forms be submitted on white paper and no colored forms will be accepted from this point forward due to the use of an electronic document management system. Paper forms are converted to images and the color is no longer useful but degrades the quality of the electronic image.
If you prefer to download a document version of Form 19—Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission (revised 8/6/08), click here. (Warning: If there is an Enter Network Password popup when you click the preceding hypertext link, click Cancel to complete the downloading process.)
| NOTE: You may modify FORM19.DOC to include the employer’s name, address, telephone number, etc., by opening the document in Microsoft® Word, choosing Tools from the Menu Bar, selecting the Unprotect Document option, and filling in the appropriate blanks. Afterwards, you must select Tools, choose Protect Document, click Forms:, click OK, and then save (Ctrl S) the document. |
You may print and fill out the following PDF (Portable Document Format) version of the Form 19—Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission (revised 8/6/08), and submit it to the commission in lieu of the NCIC’s preprinted forms. To view or print this PDF file, you first must download and install a copy of the Adobe® Acrobat® Reader. Click the button below to obtain your FREE copy of Adobe® Acrobat® Reader. (NOTE: Please pay close attention to this software’s installation instructions and licensing agreement.)
Get your free Adobe® Acrobat® Reader now!
Click here to view or download PDF versions of all N.C. Industrial Commission forms.
Click here for an updated interactive version of Form 19 created by FirstReport Software (revised 8/6/08).