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An official website of the United States government
If there were few or no work-related injuries and illnesses at your sampled establishment in calendar year 2023, you may respond to us via fax. You may select a form below based on the location of your establishment.
State Code | State Name |
---|---|
01 | Alabama |
02 | Alaska |
04 | Arizona |
05 | Arkansas |
06 | California |
08 | Colorado |
09 | Connecticut |
10 | Delaware |
11 | District of Columbia |
12 | Florida |
13 | Georgia |
66 | Guam |
15 | Hawaii |
16 | Idaho |
17 | Illinois |
18 | Indiana |
19 | Iowa |
20 | Kansas |
21 | Kentucky |
22 | Louisiana |
23 | Maine |
24 | Maryland |
25 | Massachusetts |
26 | Michigan |
27 | Minnesota |
28 | Mississippi |
29 | Missouri |
30 | Montana |
31 | Nebraska |
32 | Nevada |
33 | New Hampshire |
34 | New Jersey |
35 | New Mexico |
36 | New York |
37 | North Carolina |
38 | North Dakota |
39 | Ohio |
40 | Oklahoma |
41 | Oregon |
42 | Pennsylvania |
43 | Puerto Rico |
44 | Rhode Island |
45 | South Carolina |
46 | South Dakota |
47 | Tennessee |
48 | Texas |
49 | Utah |
50 | Vermont |
51 | Virginia |
52 | Virgin Islands |
53 | Washington |
54 | West Virginia |
55 | Wisconsin |
56 | Wyoming |
Last Modified Date: December 4, 2023