| Name | Division | Form Number | File Format |
|---|
| Abatement Form | TOSHA | n/a | PDF |
| Adjusting Entity Certification Application | Workers' Compensation | LB-3266 | PDF |
| Affidavit for RTAA Regarding Trade Affected Separating Employer | Trade Adjustment Assistance TAA | LB-1049 | PDF |
| Affidavit of Indigency | Workers' Compensation | LB-1108 | PDF |
| Affidavit of Indigency (Spanish) | Workers' Compensation
| LB-1108s
| PDF |
| Amusement Accident Report | Amusement Devices | LB-3294
LB-3246 | Online |
| Annual Inspection Report | Amusement Devices | LB-3300 | PDF |
Appeal of Agency Decision
| Unemployment Insurance - Appeals | n/a | Online |
| Application for Certificate of Competency/Commission | Boiler Unit | LB-1009 | PDF |
| Application for Client Number (for Clients of a Professional Employer Organization) | Unemployment Insurance - Employers | LB-0910 | PDF |
| Application for Permission | Boiler Unit | LB-0324 | PDF |
| Application for Transfer of Experience Rating Record | Unemployment Insurance - Employers | LB-0483 | PDF |
| Application to Install Elevators | Elevator Unit | LB -0364 | PDF |
| Apply for Unemployment Benefits | Unemployment Insurance | n/a | Online |
| Assessment of SCSEP Host Agency Training | Workforce Services | LB-1080 | PDF |
| Attendant Variance Guidelines | Boiler Unit | LB-3253 | PDF |
| Authorization and Invoice | Trade Adjustment Assistance TAA | LB-1121 | PDF |
| Boiler Accident Report | Boiler Unit | IN-0927 | PDF |
| Boiler Inspection Variance Guide and Checklist | Boiler Unit | n/a | PDF |
| Boiler Installation Permit Application | Boiler Unit | LB-0936 | PDF |
| Certificate of Non-Representation (CNR) | Workers' Compensation | LB-3252 | PDF |
| Certificate of Non-Representation (CNR) (Spanish) | Workers' Compensation | LB-3252 | PDF |
| Claim for Adjustment or Refund | Unemployment Insurance - Employers | LB-0459 | PDF |
| Combination of Application for Permit with Itinerary and Amusement Device List Form | Amusement Devices | LB-3298 | PDF |
| Declaration of Representative | Unemployment Insurance - Employers | LB-0927 | PDF |
| Dispute Certification Notice (DCN) | Workers' Compensation | LB-1096 | PDF |
| Dispute Certification Notice (Spanish) | Workers' Compensation | | PDF |
| Drug-Free Workplace Form | Workers' Compensation | LB-0977 | PDF |
| Drug-Free Workplace Form (Spanish) | Workers' Compensation | LB-0977 | PDF |
| EDPF (Spanish) | Workforce Services | LB-0624 SP | PDF |
| Employee Misclassification Tip Form | Workers' Compensation | LB-0977 | PDF |
| Employee Misclassification Tip Form (Spanish) | Workers' Compensation | LB-0977s | PDF |
| Election for Seasonal Employers | Unemployment Insurance - Employer | LB-3304 | PDF |
| Electronic Funds Transfer Agreement | Unemployment Insurance - Employers | LB-0963 | PDF |
| EMEEF Independent Contractor/Subcontractor List | Workers' Compensation | LB--3276 | PDF |
| Employer's Report of Change | Unemployment Insurance - Employers | LB-3288 (replaces LB-0792) | Online |
| Employability Development Plan (Arabic) | Workforce Services | LB-0624 AB | PDF |
| Form C-20 | First Report of Injury | Workers' Compensation | LB-0021 | PDF |
| Form C-20 | TN First Report of Injury Form - Substitute for OSHA 301 | TOSHA | LB-0021 | PDF |
| Form C-23 | Notice of Denial (Spanish) (Korean) | Workers' Compensation | LB-0283 | PDF |
| Form C-26 | Notice of Change or Termination of Benefits (Korean) | Workers' Compensation | LB-0285 | PDF |
| Form C-30a | Final Medical Report | Workers' Compensation | LB-0383 | PDF |
| Form C-31 | Medical Waiver and Consent | Workers' Compensation | LB-0379 | PDF |
| Form C-31sp | Medical Waiver and Consent (Spanish) | Workers' Compensation | LB-0379s | PDF |
| Form C-32 | Standard Form Medical Report | Workers' Compensation | LB-0369 | PDF |
| Form C-33 | Case Management Notification | Workers' Compensation | LB-0376 | PDF |
| Form C-34 | Case Management Closure Form | Workers' Compensation | LB-0377 | PDF |
| Form C-34 | Case Management Closure Instructions | Workers' Compensation | n/a | Online |
| Form C-35 | Utilization Review Notification | Workers' Compensation | LB-0380 | PDF |
| Form C-35a | Utilization Review Denial Appeal | Workers' Compensation | LB-1023 | PDF |
| Form C-35a | Utilization Review Denial Appeal (Spanish) | Workers' Compensation | LB-1023s | PDF |
| Form C-36/C-37 | Utilization Review Closure | Workers' Compensation | LB-0375 | PDF |
| Form C-36/C-37 | Utilization Review Closure Form Completion Instructions | Workers' Compensation | n/a | Online |
| Form C-38 | Case Management Registration | Workers' Compensation | LB-0965 | PDF |
| Form C-39 | Provider Registration for Utilization Review | Workers' Compensation | LB-0968 | PDF |
| Form C-40 | Request for Mediation (Spanish) | Workers' Compensation | LB-0381 | PDF |
| Form C-40 | Request for Mediation | Workers' Compensation | LB-0381 | PDF |
| Form C-41 | Wage Statement | Workers' Compensation | LB-0384 | PDF |
| Form C-42 | Agreement Between Employer/Employee Choice of Physician (Panel) (Spanish) (Korean) | Workers' Compensation | LB-0382 | PDF |
| Form C-43 | Permanent Total Disability Final Order | Workers' Compensation | LB- 0988 | PDF |
| Form C-44 | Request for Administrative Review of a WC Specialist's Order | Workers' Compensation | LB-1016 | PDF |
| Form C-47 | Medical Payment Committee Review Request | Workers' Compensation | LB-1017 | PDF |
| I-3 | Reduction in Workforce | Workers' Compensation | LB-0286 | PDF |
| I-4 | Sole Proprietor/Partner Selection / Notice of Election | Workers' Compensation | LB-0228 | PDF |
| I-4 | Aviso de Elección / Notice of Election | Workers' Compensation | LB-0228s | PDF |
| I-5 | Sole Proprietor/Partner Withdrawal of Election | Workers' Compensation | LB-0287 | PDF |
| I-5 | Aviso de Retiro / Notice of Withdrawal | Workers' Compensation
| LB-0287s | PDF |
| I-6 | Corporate Officer Election Not to Accept | Workers' Compensation | LB-0090 | PDF |
| I-7 | Corporate Officer Withdrawal of Election | Workers' Compensation | LB-0288 | PDF |
| I-8 | Exempt Employers Notice of Acceptance | Workers' Compensation | LB-0014 | PDF |
| I-8 | Exempt Employers Notice of Acceptance (Spanish) | Workers' Compensation | LB-0014s | PDF |
| I-9 | Exempt Employers Withdrawal of Notice | Workers' Compensation | LB-0289 | PDF |
| I-9 | Exempt Employers Withdrawal of Notice (Spanish) | Workers' Compensation | LB-0289s | PDF |
| I-10 | Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions | Workers' Compensation | LB-0030 | PDF |
| I-10 | Notice of Waiver of Workers' Compensation Benefits for Specific Medical Conditions (Spanish) | Workers' Compensation | LB-0290s | PDF |
| I-13 | Waiver Withdrawal | Workers' Compensation | LB-0290 | PDF |
| I-14 | Common Carrier Election / Termination of Coverage Form | Workers' Compensation | LB-0300 | PDF |
| I-14 | Common Carrier Election / Termination of Coverage Form (Spanish) | Workers' Compensation | LB-0300s | PDF |
| I-15 | General Contractor Acceptance / Termination of Coverage Agreement Form | Workers' Compensation | LB-0301 | PDF |
| I-18 | Notice of Discontinuance | Workers' Compensation | n/a | PDF |
| Illegal Alien Complaint Form | Labor Standards | LB-0989 | PDF |
| Incumbent Worker/On the Job Training Grant | Procedures and Application Requirements | Workforce Services | LB-3250 | PDF |
| Instructions for Completing the Petition | TAA & ATAA Petitions | ETA-9042 | PDF |
| Instructions for Completing the Petition (Spanish) | TAA & ATAA Petitions | ETA-9042A | PDF |
| Job Order Transmittal | Unemployment Insurance - Employers | LB-0610 | PDF |
| Job Placement Verification | Workforce Services | LB-1124 | PDF |
| Job Placement Verification (Spanish) | Workforce Services | LB-1124 SP | PDF |
| Job Search Activity Verification | Trade Adjustment Assistance TAA | LB-1119 | PDF |
| Job Search Allowances Application | Trade Adjustment Assistance TAA | LB-1117 | PDF |
| Job Search Payment Form | Trade Adjustment Assistance TAA | LB-1116 | PDF |
| License to Engage | Boiler Unit | LB-0386 | PDF |
| Medical Record Certification | Workers' Compensation | LB-1097 | PDF |
| Medical Record Certification (Spanish) | Workers' Compensation
| LB-1097 | PDF |
| Request for Medical Impairment Rating (MIR) | Workers' Compensation | LB-0930 | PDF |
| Request for Medical Impairment Rating (MIR) (Spanish) | Workers' Compensation | LB-0930s | PDF |
| MIR Application for Appointment to the Medical Impairment Rating Registry | Workers' Compensation | LB-928A | PDF |
| CPP Application for Appointment to the Certified Physician Program Registry | Workers' Compensation | LB-928A | PDF |
| MIR Impairment Rating Report - 5th Edition | Workers' Compensation | LB-0931 | PDF |
| MIR Impairment Rating Report - 6th Edition | Workers' Compensation | LB-0931A | DOCX |
| MIR Medical Waiver and Consent Form | Workers' Compensation | LB-0929 | PDF |
| MIR Medical Waiver and Consent Form (Spanish) | Workers' Compensation | LB-0929 | PDF |
| Notice of Demand for Examination | Workers' Compensation
| LB-201 | PDF |
| Notice of Employer Rights and Responsibilities | Workers' Compensation | LB-3265 | PDF |
| Notice of Appeal | Unemployment Insurance - Appeals | LB-0897 | PDF |
| Workers' Compensation Notice of Appeal | Workers' Compensation | LB-1099 | PDF |
| Workers' Compensation Notice of Appeal (Spanish) | Workers' Compensation
| LB-1099 | PDF |
| Notice of Primary Liaison | Workers' Compensation | LB-3263 | PDF |
| Notice of Reported Work Injury (Spanish) (Korean) | Workers' Compensation | | PDF |
| Occupational Injury and Illness Record Keeping Forms | TOSHA | OSHA 300 | PDF |
| Occupational Injury and Illness Record Keeping Forms | TOSHA | OSHA 300 | Excel |
| Parental Consent Form | Child Labor Laws | Labor Standards | LB-0355 | PDF |
| Petition for Benefit Determination (PBD) | Workers' Compensation | LB-1095 | PDF |
| Petition for Benefit Determination (Spanish) | Workers' Compensation | LB-1095 | PDF |
| Petition for Benefit Determination Settlement Approval Only | Workers' Compensation | LB-1120 | PDF |
| Addendum to PBD (for Death Claims Only) | Workers' Compensation | LB-1095-A | PDF |
Addendum to PBD (for Death Claims Only) (Spanish)
| Workers' Compensation | LB-1095-A | PDF |
| Addendum to PBD (for Multiple Employers Only) | Workers' Compensation
| | PDF |
| Addendum to PBD (for Multiple Employers Only) (Spanish) | Workers' Compensation
| | PDF |
| Physician Certification Form | Workers' Compensation | LB-1109 | PDF |
| Posting Notice (Spanish) (Korean) | Workers' Compensation | LB-0922 | PDF |
| Re-Employment Services (RESEA) Employability Development Plan | Workforce Services | LB-0624 | PDF |
| Re-Employment Services (RESEA) Initial Assessment | Workforce Services | LB-1084 | PDF |
| Re-Employment Services (RESEA) Initial Assessment (Spanish) | Workforce Services | LB-1084 SP | PDF |
| Replacement of Stamped Data Form | Boiler Unit | NB-136 | PDF |
| Report a Safety or Health Hazard | Complaint Form | TOSHA | TOSHA-7 | PDF |
| Report to Determine Status - Application for Employer Number | Unemployment Insurance - Employers | LB-0441 | PDF |
| Report to Determine Status - Nonprofit Organizations, Private Primary, Secondary Schools | Unemployment Insurance - Employers | LB-0444 | PDF |
| Report to Determine Status - State and Local Government | Unemployment Insurance - Employers | LB-0443 | PDF |
| Request for Benefits from the UEF | Workers' Compensation | LB-3284 | PDF |
| Request E-Verify | Labor Standards | n/a | PDF |
| Request for Completion TRA Benefits | Trade Adjustment Assistance TAA | LB-1106 | PDF |
| Request for Consultative Services | TOSHA | LB-1010 | PDF |
| Request for Consultative Services | TOSHA | LB-1010 | Online |
| Request for Eligibility Reemployment Trade Adjustment Assistance (RTAA) | Trade Adjustment Assistance TAA | LB-1053 | PDF |
| Request for Expedited Determination - Appeal of a Denied Prescription | Workers' Compensation | LB-1123 | PDF |
| Request for Translation of Document for WC Appeal | Workers' Compensation | | PDF |
| Request for Translation of Document for WC Appeal (Spanish) | Workers' Compensation | | PDF |
| Hearing Request | Workers' Compensation | LB-1098
| PDF |
| Hearing Request (Spanish) | Workers' Compensation | | PDF |
| Request for Initial Reemployment Data on RTAA | Trade Adjustment Assistance TAA | LB-1122 | PDF |
| Request for Investigation | Workers' Compensation | LB-0977 | PDF |
| Request for Investigation (Spanish) | Workers' Compensation | LB-0977s | PDF |
| Request For Prior Work Injury Information | Workers' Compensation | LB-3271 | PDF |
| Request for Settlement Approval (RSA) | Workers' Compensation | LB-0932 | PDF |
| Request for Tennessee High School Equivalency Verification, Transcript or Duplicate Diploma | Adult Education | n/a | Online |
| Request to Reschedule Hearing | Unemployment Insurance - Appeals | LB-0896 | PDF |
| Request to Subpoena | Unemployment Insurance - Appeals | LB-0895 | PDF |
| Request to Withdraw Appeal | Unemployment Insurance - Appeals | LB-0894 | PDF |
| RESEA Checklist | Workforce Services | LB-1084 | PDF |
| RESEA Checklist (Arabic) | Workforce Services | LB-3279 AB | PDF |
| RESEA Checklist (Spanish) | Workforce Services | LB-3279 SP | PDF |
| RESEA Claimant's Statement | Workforce Services | LB-1021 | PDF |
| RESEA Claimant's Statement (Arabic) | Workforce Services | LB-1021 AB | PDF |
| RESEA Claimant's Statement (Spanish) | Workforce Services | LB-1021 SP | PDF |
| RESEA Control Form | Workforce Services | LB-3280 | PDF |
| RESEA Control Form (Arabic) | Workforce Services | LB-3280 AB | PDF |
| RESEA Eligibility Review | Workforce Services | LB-1022 | PDF |
| RESEA Eligibility Review (Arabic) | Workforce Services | LB-1022 AB | PDF |
| RESEA Eligibility Review (Spanish) | Workforce Services | LB-1022 SP | PDF |
| RESEA Initial Assessment (Arabic) | Workforce Services | LB-1084 AB | PDF |
| RESEA Job Placement Verification (Arabic) | Workforce Services | LB-1124 AB | PDF |
| RESEA Subsequent Visit Acknowledgement Form (Arabic) | Workforce Services | LB-3286 AB | PDF |
| SCSEP IEP | Workforce Services | n/a | PDF |
| SCSEP Participant Packet | Workforce Services | n/a | PDF |
| SCSEP Quarterly Progress Data | Workforce Services | n/a | PDF |
| SD1 Statistical Data Form | Workers' Compensation | LB 0904 | PDF |
| SD-2 Statistical Data Form | Workers' Compensation | | PDF |
| Separation Notice | Unemployment Insurance - Employers | LB-0489 | PDF |
| Signature of Authority for Training Facility Officials (TAA) | Workforce Services | LB-0898 | PDF |
| SNAP E&T Monthly Attendance Record | Workforce Services | LB-3258 | PDF |
| SNAP E&T Potential Partner Assessment | Workforce Services | LB-3255 | PDF |
| SNAP E&T Title I Referral | Workforce Services | LB-3259 | PDF |
| Social Security Number Correction | Unemployment Insurance - Employers | LB-0755 | PDF |
| Subpoena | Workers' Compensation | LB-0476 | PDF |
| Subpoena (Spanish) | Workers' Compensation
| LB-0476 | PDF |
| TAA-ATAA Participant Selection Form | TAA & ATAA | | PDF |
| TAA Participant Non-Compliance Warning | Trade Adjustment Assistance TAA | LB-1107 | PDF |
| TAA Release of Information Agreement | Trade Adjustment Assistance TAA | LB-3281 | PDF |
| TAA Training Financial Support Statement | Workforce Services | LB-1090 | PDF |
| TAA Training Packet Checklist | Workforce Services | LB-1047 | PDF |
| TAA Training Provider Checklist | Trade Adjustment Assistance TAA | LB-0948 | PDF |
| TAA-WIOA Training Referral | Trade Adjustment Assistance TAA | LB-0738 | PDF |
| Taxable Wage Correction | Unemployment Insurance - Employers | LB-3241 | PDF |
| Tennessee Public High School - Duplicate Diploma Request | Department of Education | ED-5175 | PDF |
| Training Facility TAA Follow-Up Notice | Trade Adjustment Assistance TAA | LB-0785 | PDF |
| Verification of Employment for Monthly Wage Supplement | Trade Adjustment Assistance TAA | LB-1050 | PDF |
| Violation of TN Lawful Employment Act Complaint Form | Labor Standards | LB-1082 | PDF |
| Wage and Premium Reports | Unemployment Insurance | LB-0456
LB-0851 | PDF |
| Wage Complaint Form | Workplace Regulations & Compliance (Labor Standards Unit) | LB-0995 | Form |
| Weekly Request for Allowance by Worker in Training | Trade Adjustment Assistance TAA | LB-0429 | PDF |
| Willing to Commute | Trade Adjustment Assistance TAA | LB-1089 | PDF |
| Worker Training Agreement and Responsibilities | Trade Adjustment Assistance TAA | LB-1092 | PDF |