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Revised: 1/1/2013 1 of 3 INSTRUCTIONS: HOW TO FILL OUT THE "WITNESS AND EXHIBIT LIST" USE THIS FORM ONLY if a petition/complaint and an answer/response .
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· Worker''s Compensation Agency ... WC100 (2/13) Employer''s Basic Report of Injury (fillin form) Form WC100 utilizes Optical Character Recognition (OCR ...
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· Worker''s Compensation Agency ... WC107 (2/13) Notice of Dispute (fillin form) Form WC107 utilizes Optical Character Recognition (OCR) to scan data.
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