WORKERS’ COMPENSATION HISTORY CHECKS

KENTUCKY

Records can be obtained free of charge by submitting a faxed request.

  1. Prepare the Open Records Act Fax Transmittal form: Enter your company name, address, fax number & e-mail address in the heading space. (This information MUST be provided).
  2. Prospective Employee completes and signs Disclosure Release form andJob Application.
  3. Prospective Employee is interviewed and Contingent Offer is extended.
  4. Employer completes the Open Records Act Fax Transmittal by enteringthe Prospective Employees name and social security number.
  5. Fax the request to the name and fax number listed on the form.
  6. Report will be mailed to your office within 3 to 5 days.

INDIANA

Records can be obtained for a charge of $.10 per page by submitting a mail request. Report will be mailed to your office in within 5 to 10 days.

  1. Prepare the Indiana Workers Comp History Check Request form. Enter your company name, address, phone number & e-mail address in the heading space.
  2. Prospective Employee signs dates Indiana Worker’ Comp History Check Request.
  3. Prospective Employee is interviewed and Contingent Offer is extended.
  4. Employer Enter the employee’s name and social security number.
  5. Employee MUSTsign the form in the space provided.
  6. The form MUST be notarized.
  7. Mail the ORIGINAL form to: Sandy Maskell

Workers’ Compensation Board of IN

402 W. Washington St., Room W-196

Indianapolis, IN 46204

Ph: 317-232-3810

TENNESSEE

Records can be obtained by calling the TN Department of Workers’ Compensation. There is no charge for a verbal report. Written reports can be obtained for $10.

  1. Prospective Employee completes Disclosure Release form / Application.
  2. Prospective Employee is interviewed and Contingent Offer is extended.
  3. Employer calls 800-332-2667 to acquire the Workers’ Compensation History
  4. Ask for Workers’ Compensation Record Look-Up
  5. Provide employee name and social security number.
  6. Records to 1992 can be obtained & provided while you wait. Records prior to 1992 are maintained on micro-film and will require a longer wait.

VIRGINIA

Records can be obtained by submitting a mailed, notarized request. There is a $10.00 charge per individual. Check / Money Order should be made payable to the Virginia Workers’ Comp. Commission.

1. Prepare the Open Records Act Fax Transmittal form: Enter your company name, address, fax number

& e-mail address in the heading space. (This information MUST be provided).

2. Prospective Employee completes and signs Disclosure Release form and Job Application.

3. Prospective Employee is interviewed and Contingent Offer is extended.

4. Employer completes the Open Records Act Fax Transmittal by entering the Prospective Employees

name and social security number and has the Open Records Act Fax Transmittal form notorized.

5. Mail the completed request to: Iris Peace

Virginia Workers’ Compensation Board

1000 DMV Drive

Richmond, VA23220

ILLINOIS

Records can be obtained by calling the Illinois Department of Workers’ Compensation. There is no charge for a verbal report. Written reports can be obtained for a fee.

1. Prospective Employee completes Disclosure Release form / Application.

2. Prospective Employee is interviewed and Contingent Offer is extended.

3. Employer calls 312-814-6611 to acquire the Workers’ Compensation History

4. Ask for Workers’ Compensation Record Look-Up

5. Provide employee name and social security number.

6 Records to 1982 can be obtained & provided while you wait. Records prior to 1982 and / or claim files

will require a longer wait and Employer will be charged a fee.