Safety Grants

The State of Maine’s central fund for Workers’ Compensation shall provide limited resources to assist departments in developing and introducing safety and loss prevention initiatives. Each agency contributing to the central fund is eligible to receive up to $5000.00 as an annual grant to support the department. In order to receive the grant, the department must confirm that these funds will be used exclusively for safety and loss prevention activities. The purpose of these activities would be to provide a safe and healthy environment for employees and to reduce the number, severity, and potential costs of illnesses, injuries, and harmful activities.

• Safety Grant application and supporting documents (PDF) 

Departmental Designees

• Employee’s First Report of Injury (MS-Word)
• New Vendor form (PDF)
• WCB-220 General Release of Medical Information (PDF) 
• WCB-220-A Limited Release of Protected Medical Information (PDF)
• Benefit Leave Option form (PDF)
• New Workers' Compensation policy on coordination of benefits (PDF)
• COVID-19 Protocols (PDF)

Employees

• Mileage Expense Reimbursement Form (PDF)

Supervisors

• Supervisor’s Report (MS-Word)
• Witness Report (MS-Word)