Forms & Applications Apprenticeship Sponsor Registration Register Apprenticeship Program PDF file, less than 1mbmegabytes Guide to NAICS Industry Codes PDF file, less than 1mbmegabytes Company Ratio Sheet PDF file, less than 1mbmegabytes Education Providers List PDF file, less than 1mbmegabytes Apprentice Registration Register an Apprentice PDF file, less than 1mbmegabytes Apprenticeship Agreement PDF file, less than 1mbmegabytes Cancel an Apprentice PDF file, less than 1mbmegabytes Certify Apprentice Completion PDF file, less than 1mbmegabytes Request Extra Time to Complete PDF file, less than 1mbmegabytes Sample Monthly Record Book PDF file, less than 1mbmegabytes Request Reciprocal Recognition PDF file, less than 1mbmegabytes Info Sheets and Publications Credits for Prior Learning PDF file, less than 1mbmegabytes Veterans Education Benefits PDF file, less than 1mbmegabytes How High Schools connect with Apprenticeship PDF file, less than 1mbmegabytes Overview of Apprenticeship Funding PDF file, less than 1mbmegabytes The Federal Resources Playbook for Registered Apprenticeship PDF file, less than 1mbmegabytes Highlights on Equal Opportunity PDF file, less than 1mbmegabytes EEO Applicant Self Identification PDF file, less than 1mbmegabytes Equal Opportunity in Apprenticeship Poster PDF file, less than 1mbmegabytes Apprenticeship Toolkit PDF file, about 2mbmegabytes Temporary Disability Insurance For Claimants Online Resources Request a 1099 Form for TCI Claimants Forms English Direct Deposit request Form and Money Network EPC Card Fees PDF file, less than 1mbmegabytes Spanish Direct Deposit request Form and Money Network EPC Card Fees PDF file, less than 1mbmegabytes TX-16-24 PDF file, less than 1mbmegabytes Publications COVID-19 Sick Leave Options PDF file, less than 1mbmegabytes Medical Form Instructions PDF file, less than 1mbmegabytes Medical Form Instructions (Espanol) PDF file, less than 1mbmegabytes Partial Return to Work PDF file, about 2mbmegabytes TDI-TCI Claimant Information Pamphlet PDF file, about 2mbmegabytes TDI-TCI Claimant Information Pamphlet - Spanish PDF file, about 2mbmegabytes For Employers Publications TDI for Employers Brochure PDF file, less than 1mbmegabytes 2024 UI/TDI Quick Reference PDF file, less than 1mbmegabytes For Healthcare Providers Forms Impartial Medical Examiner's Agreement PDF file, less than 1mbmegabytes Application For Medical Examiner PDF file, less than 1mbmegabytes W-9 PDF file, less than 1mbmegabytes Publications What Qualified Healthcare Providers Need to Know PDF file, less than 1mbmegabytes Unemployment Insurance For Claimants Online Resources File a UI Claim Certify for Weekly Payment Appeal a Decision Tuition Waiver Request a 1099 Form Adjudication Questionnaires UI Forms for Claimants Request for Dependency Information PDF file, less than 1mbmegabytes Return to Work Form PDF file, less than 1mbmegabytes Update Your Tax Withholding Information PDF file, less than 1mbmegabytes Work Search Activity Log PDF file, less than 1mbmegabytes Work Search Activity Log (excel) Excel file, less than 1mbmegabytes Registro de búsqueda de trabajo PDF file, less than 1mbmegabytes Registro de búsqueda de trabajo Excel file, less than 1mbmegabytes UI Publications for Claimants DUA Benefit Rights and Responsibilities PDF file, less than 1mbmegabytes Guide to Filing an Unemployment Insurance Claim PDF file, less than 1mbmegabytes UI Benefits Rights and Responsibilities - English PDF file, less than 1mbmegabytes UI Benefits Rights and Responsibilities - Spanish PDF file, less than 1mbmegabytes UI Claimant Information Pamphlet PDF file, about 1mbmegabytes UI Claimant Information Pamphlet - Spanish PDF file, about 1mbmegabytes For Employers Online Resources Protest Benefit Charge Appeal a Decision Update Address for UI Forms Report a New Hire Adjudication Questionnaires UI Forms for Employers Relief of Benefit Charges and Waiting Period Waiver Due to a National Disaster/State of Emergency PDF file, less than 1mbmegabytes UI Publications for Employers 2024 UI/TDI Quick Reference PDF file, less than 1mbmegabytes Employer Handbook PDF file, about 4mbmegabytes WorkShare Resources Application Packet PDF file, less than 1mbmegabytes Participant List Form PDF file, less than 1mbmegabytes Shared Work Payment Calculation Chart PDF file, less than 1mbmegabytes Workshare FAQs for Employers PDF file, less than 1mbmegabytes WorkShare Updates PDF file, less than 1mbmegabytes Incumbent Worker Training Incumbent Worker Training Program Application PDF file, less than 1mbmegabytes Layoff Aversion / Business Retention Incumbent Worker Training Program Guidelines PDF file, less than 1mbmegabytes Employer Tax Unit Employer Tax Forms BAR PDF file, less than 1mbmegabytes TDI Affidavit PDF file, less than 1mbmegabytes TX-10 PDF file, less than 1mbmegabytes TX-13 PDF file, less than 1mbmegabytes TX-139 PDF file, less than 1mbmegabytes TX-16-24 PDF file, less than 1mbmegabytes TX-17-21 PDF file, less than 1mbmegabytes TX-17-22 PDF file, less than 1mbmegabytes TX-17-23 PDF file, less than 1mbmegabytes TX-17-24 PDF file, less than 1mbmegabytes TX-36 PDF file, less than 1mbmegabytes TX-68b PDF file, less than 1mbmegabytes Update Employer Account Information PDF file, less than 1mbmegabytes Workers' Compensation Claims Forms First Report of Injury An injury must be reported if medical treatment is needed, if the injured worker is unable to earn full wages for at least 3 days, or if the injury is fatal. Injured workers and employers do not send a paper first report to RI DLT. A worker reports an injury to the employer. The employer reports the injury to the claim administrator, which is the insurer or the adjusting company handling the claim. The claim administrator reports electronically to RI DLT. No first report forms are accepted on paper. Indemnity Benefits Start A legal agreement to begin compensation is required unless benefits are paid by court order. Benefits may paid without liability for 13 weeks under a Nonprejudicial Agreement (DWC-20) or with liability under a Memorandum of Agreement (DWC-02). In both cases, a Wage Statement and Dependency Form are required as part of the agreement. Nonprejudicial Agreement Form DWC-20 (without liability, up to 13 weeks) Memorandum of Agreement Form DWC-02 (with liability) Wage Statement Form DWC-03 Certificate of Dependency Form DWC-04 Indemnity Benefits Change, Payment of Disfigurement or Loss of Use A Mutual Agreement is required to change benefits, or to pay disfigurement or loss of use benefits: Mutual Agreement Form DWC-24 Indemnity Benefits Stop A legal document is required when indemnity benefits end. Benefits paid without liability under a Nonprejudicial Agreement may be ended with a Termination of Benefits Form DWC-21. Benefit paid with liability may be ended with a Suspension Agreement and Receipt Form DWC-05 or a Wage Transcript Form DWC-30.An employee may object if benefits are ended by a Wage Transcript. Termination of Benefits Form DWC-21 (without liability) Suspension Agreement and Receipt Form DWC-05 (with liability) Wage Transcript Form DWC-30 Employee Objection to Wage Transcript Form DWC-31 Indemnity Benefits Reduced on Retirement Indemnity benefits may be reduced upon retirement. Coordination of Benefits Form DWC-36 Compensation Benefit Checks Compensation must be paid weekly and by check unless the employee and insurer agree to electronic funds transfer. Claim Administrators must notify employee of duty to report earnings. Notice may be given by sending Notice on Benefit Check Form DWC-32, printing the notice on the check, or including notice in the agreement for electronic funds transfer. Agreement for Electronic Payment of Benefits Form DWC-EB1 Rescission of Agreement for Electronic Payment of Benefits Form DWC-EB2 Notice on Benefit Check Form DWC-32 (Español) Duty to Report Earnings An employee must submit a report of earnings to the claim administrator upon written request. Report of Earnings Form DWC-25 Partial Incapacity Gate When benefits paid under § 28-33-18(d) end at the Partial Incapacity Gate, § 28-35-46.1 requires an Itemized Statement of the total amount of compensation and expenses paid be filed with RI DLT within 60 days of benefits end. ONLY claims closed at the Partial Incapacity Gate require an Itemized Statement. Itemized Statement Form DWC-50 Insurance Coverage and Exemption Forms Insurance Coverage Employers with one or more employees must obtain workers’ compensation insurance coverage. Employers are required to post the name and contact information for their workers’ compensation insurer. Employers must post workers’ compensation insurer name and contact information. Electronic Notice of Insurance Policy through NCCI Insurers are required to notify RI DLT when a workers’ compensation policy is issued or changed WC Act Summary Poster DWC-8 (Español) Temporary Employment and Employee Leasing Companies Insurance Coverage Verification DWC-9 Issued by Insurance Company to all certificate holders. Waiver and Election Notice of Claim of Common Law Rights (DWC-11) Known as a waiver form, the signer waives his rights under the RI Workers’ Compensation Act in order to claim rights under common law. Rescind Notice of Claim of Common Law Rights (DWC-11R) Signer regains rights under the RI Workers’ Compensation Act Election by Exempt Corporate Officer to Become Subject to Workers’ Compensation (DWC-11C) This form only applies to any person who was appointed a corporate officer and was not previously an employee of the corporation. If you believe this is the correct form for you, please call (401) 462-8100 for more information. Self Insurance Forms Application for Approval of Workers' Comp Self-Insurance Program Form RI SI-2 Self-Insured Renewal Application Form RI SI-2a Bond of Employer Authorized to pay Workers' Compensation benefits Directly to Employees or their Dependents Form RI SI 5 Initial Surety Bond Extension Agreement RI DI 5a Bond of Employer Authorized to pay Workers' Compensation benefits Directly to Employees or their Dependents RI SI 5b Former Bond of Employer Authorized to pay Workers' Compensation benefits Directly to Employees or their Dependents RI SI 5c Backdate Standby Letter of Credit Form RI SI 6 Escrow Agreement Form RI SI 7 Trust Agreement Form RI SI 7a Certificate of Deposit Agreement Form RI SI 7b Certification Form RI SI 9 Certification Form RI SI 9a Indemnity Agreement Form RI SI 10 Claim Loss Summary Form RI SI 14a Required Data Fields Claims Listing Form RI SI 14b Calculated Security Requirement Form RI SI 15 Self-Insurance Agreement Form RI SI 17 Self-Insurance Agreement Continuation, Extension, and/or Amendment Form RI SI 17b Electronic Filing Forms EDI Information Independent Contractor Forms Designation of Status as an Independent Contractor This form clarifies the relationship between a contractor and the business hiring the contractor. Submitting this form means that the contractor is not an employee of the hiring business for workers' compensation purposes. The contractor is responsible for his own workers' compensation insurance coverage. The hiring business is not responsible to provide workers' compensation coverage for the independent contractor. Notice of Withdrawal of Designation of Independent Contractor This form ends the relationship between a contractor and the hiring business. Submitting this form means that the contractor is no longer independent of the hiring business named on this form. If the contractor continues to work for this business, the business would be responsible to provide workers' compensation coverage for the contractor. Medical Forms Notification of Claim of Compensable Injury DWC-29 Physician's Notice of Release to Work DWC-27/28 Request for Additional Palliative Care DWC-40 Arrigan Center Patient Forms Physician referal form Record Request Name Change First Appointment Intake Form Customer Satisfaction Survey in English (Español) Uninsured Protection Fund Forms UPF Notice of Claim Form Nonresident Employer Service of Process Agent For Service Designation Publications Education Unit Calculation of Compensation Rate Calculación de Tarifa de Compensación Employee Information - English and Spanish Health and Safety Committees Comites de Salud & Seguridad Medical Services and Treatment Servicios Médicos y Tratamiento Right to Reinstatement El Derecho De Reinstauración What Employers Should Know About Workers' Comp Lo Que Los Epleadores Necesitan Saber Sobre la Compensacion de Trabajadores What Medical Providers Should Know about Workers' Comp Claims Training: Claim Filing Instructions Claim Reporting Requirements EDI Training RI Dept. of Labor and Training Claim Event Guide EDI Basics for Claim Adjusters External Resources The Occupational Safety & Health Administration The National Institute for Occupational Safety and Health Fraud Unit Initial Information Report Form Report of Earnings Form Notice to Employees Regarding the Effect of Endorsement of Benefit Check What is WC Fraud and How to Prove It Workforce Regulation and Safety Labor Standards Workplace Posters Required Posters For The Workplace Forms Nonpayment of Wages Complaint Form PDF file, less than 1mbmegabytes Nonpayment of Wages Complaint Form (Español) PDF file, less than 1mbmegabytes Mandatory Overtime (Nurses/Hospitals) Complaint Form PDF file, less than 1mbmegabytes Pay Equity Complaint Form PDF file, less than 1mbmegabytes Intention to Employ Minor PDF file, less than 1mbmegabytes Special Limited Permit to Work for minors 14-15 years of age PDF file, less than 1mbmegabytes Employee Bi-Weekly Pay Application PDF file, about 1mbmegabytes Bi-Weekly Pay Affidavit of Continued Compliance PDF file, less than 1mbmegabytes Publications A Guidebook to Rhode Islands Wage and Workplace Laws PDF file, about 6mbmegabytes Child Labor Laws - Youth Employment Resources Pamphlet PDF file, about 1mbmegabytes Child Labor Laws - Youth Employment Resources Pamphlet - Spanish PDF file, about 1mbmegabytes Occupational Safety Elevator Safety Forms Application for Permit to Install or Modernize Vertical Devices (Español) Application for Exam - Mechanic Installer (Español) Application for a COMPANY License Notice of Decommission Form Request for Initial State Inspection Checklists Electric Elevator Inspection Check List (DLT-L129) Hydraulic Elevator Inspection Check List (DLT-L130) Escalator Inspection Check List (DLT-L133) Wheelchair Lifts, Inclined Wheelchair Lifts and Stairway Chairlifts - ASME A18.1 (DLT-L133) Completed forms may be submitted to: Elevator Unit RI Dept. of Labor and TrainingCenter General ComplexP.O. Box 201571511 Pontiac Ave. Cranston RI 02920 Fax: (401) 462-8576 Boiler Safety Hot Water Heater Safety Brochure Application for Permit to Install Boilers Solicitud de Permiso de Instalación de Calderas Laws, Rules and Regulations Right-to-Know Forms Hazardous Substance Right-to-Know Annual Registration Form Hazardous Substance List Alphabetical by CAS Number Right to Know Complaint Form (Español) Annual Registration Form Completed forms may be submitted to: Right to Know UnitRI Dept. of Labor and TrainingCenter General ComplexP.O. Box 201571511 Pontiac Ave. Cranston RI 02920 Fax: (401) 462-8576 Publications Right to Know Brochure Sara Title III Emergency Planning Community Right to Know Booklet Weights and Measures Petroleum Dealers License Application Form (Español) Prevailing Wage Required Posters Prevailing Wage (Espanol) Forms Complaint Form Please note - this form MUST be signed in the presence of a Prevailing Wage Investigator Both forms must be completely filled out. Call (401) 462-8580, option 7 to schedule an appointment Referral Form Please note - this form MUST be signed in the presence of a Prevailing Wage Investigator Both forms must be completely filled out. Certified Weekly Payroll and Statement of Compliance FormInstructions (Español) Certified Prevailing Wage Daily Log Apprenticeship Requirement Complaint Form (Español Awarding Authority Referral Form for Noncompliant Contractors Subcontractor Apprenticeship Certification Form General Contractor Apprenticeship Certification Form General Contractor Apprenticeship Re-Certification and Certification Form *Proposed Prevailing Wage Contract Addendum for State/Quasi *Proposed Prevailing Wage Contract Addendum for Municipalities Conformance Request for Labor Certification Verification of Secretary of State Registration * Any violation of RIGL 37-13-13 of Certified Weekly Payroll Forms and Daily Logs will result in the department imposing a penalty on the contractor of a minimum of one hundred dollars ($100) for each calendar day of noncompliance. Publications Advisory Regarding Payment of Fringe Benefits to Apprentices on Prevailing Wage Projects Notice to Employees working on State/Municipal Financed Construction Projects (Español) Professional Regulation Burglar and Hold-Up Alarm Application for Alarm Business License (en español) Business Renewal for Alarm Business License (en español) Application and Instructions for Alarm Agent License (en español) Renewal for Alarm Agent License (en español) Authorization for Background Check and Release (en español) Bond of Burglar Alarm Business to the General Treasurer Public Complaint Form (en español) Electrician Application for an Electrician's License (en español) Electrical Contractor/Corporations Application (en español) Application for a Limited Premise Electrical License (en español) Renewable Energy Application and Exemption Form (en español) 2020 Electrical Code Update Providers OSHA 15 Hour Electrical Trainers 15 Hour Certificate of Completion 2017 15 Hour Certificate of Completion 2020 Hoisting Hoisting Engineer Application (Español) Hoisting Exemption Form Operator Trainee License Application (Español) Health Card - Medical Examination Report Mechanicals Mechanical Application Form (Español) Mechanical Corporation Plumbing Plumbing and Irrigating Application Form (Español) Plumbing Corporation Water Filtration Application Form (Español) Telecommunications Telecommunications Form (Español) Telecommunications Corporate Application Form (Español) Additional Forms Master License Exemption Form Apprentice Completion Company Ratio Sheet
Relief of Benefit Charges and Waiting Period Waiver Due to a National Disaster/State of Emergency PDF file, less than 1mbmegabytes
Layoff Aversion / Business Retention Incumbent Worker Training Program Guidelines PDF file, less than 1mbmegabytes