Forms

Arkansas

These forms are included in your injured worker packet.

Notice of Injury
Complete this form and send a copy to Summit. Please remember that this form has two sides, both of which must be completed to process your compensation benefits.

Travel Reimbursement
Your mileage may be reimbursed for travel to and from a medical provider. To receive this benefit, you must complete this form and return it to Summit.

First Report of Injury
You must sign this form, have it witnessed and return it to Summit in order for us to process your compensation.