Resources & Forms

Employee Quick Reference Guide

Access important forms, program documents, and helpful reference materials related to the Public Education Employee Injury Compensation Program (PEEICP). Select a resource below to download or learn more.

Injury Reporting Forms

Everything needed to report a workplace injury.

First Report of Injury

Accident Report Form

How to File an On-the-Job Injury Claim

Medical Forms

Resources related to medical treatment and reimbursement.

Medical Records Authorization

Medical Reimbursement Instructions

Copay & Deductible Reimbursement Request

Program Documents

Proposed Administrative Code

Mary Anne Leonard Educators’ On-the-Job Injury Act (Executed Act)

Frequently Asked Questions (Coming Soon)

Health Plan Coordination

Learn how PEEICP coordinates with your health coverage.

PEEICP & PEEHIP/Blue Cross Blue Shield Coordination Guide

PEEICP & Viva Health Coordination Guide

Frequently Questions About Health Plan Coordination(Coming Soon)