Vermont Employer's Liability and Workers' Compensation Poster Required

Employer’s Liability and Workers’ Compensation
NOTICE TO EMPLOYEES
This employer,
__________________________________________ , has
complied with the provisions of Title 21 of the Vermont Statutes, Annotated
§687, by obtaining Workers’ Compensation Insurance coverage through:
(Insurance Carrier)
Workers’ Compensation benefits for lost time, medical expenses, disability
or death because of a work-related injury are available through the abovenamed company.
 An injured employee MUST immediately notify his/her employer of an
injury.
 The employer MUST file an Employee Claim and Employer’s First Report
of Injury (Form 1) with the Vermont Department of Labor within 72 hours
of the notice of an injury that requires medical attention or results in time
lost from work. The employer must also provide a copy of the Form 1 to
the injured worker and to the insurance carrier.
 If the employer fails to file a First Report, an employee may file a Notice of
Injury and Claim for Compensation (Form 5) with the Vermont Department
of Labor within six months of the date of injury.
 Information about injured worker rights and benefits is available on the
Department’s
Workers’
Compensation
website
at
labor.vermont.gov/workers-compensation or by calling (802) 828-2286 or
TDD 800-650-4152.
WC-10 (10/2025)

Equal Opportunity is the Law
The State of Vermont is an Equal Opportunity/Affirmative Action Employer. Applications from women, individuals with
disabilities, and people from diverse cultural backgrounds are encouraged. Auxiliary aids and services are available upon request
to individuals with disabilities.