Workers' Compensation First Report of Injury Forms and Additional Documents
First Report of Injury forms are state specific. Click on your state to open the appropriate form and other related documents.
When you have completed the necessary forms, you can submit them to Church Mutual via fax at (715) 539-4651 or by mail at Church Mutual Insurance Company, S.I., P.O. Box 342, Merrill, WI 54452-0342.