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Pennsylvania Compliance

Posting Requirements 77 PS 305(e)(2)

Employers are required to post form LIBC-500, "Remember: It is important to tell your employer about your injury," to inform employees of the name, address and phone number of their workers' compensation insurance company, their third-party administrator or internal workers' compensation contact person.


New Rule effective 8/4/2007 77 PS 21.3b Providing workers' compensation information.

The workers' compensation information specified in subsection (b) of the rule must be provided to every employee at the time of hire and immediately after the injury, or as soon thereafter as possible under the circumstances of the injury. If the employee's injuries are so severe that emergency care is required, the information shall be given as soon after the occurrence of the injury as is practicable

There is no State form available from the Pennsylvania Bureau of Workers' Compensation. The form must contain the pertinent information and be printed on paper no smaller than 8 1/2 x 11 and in font no less than 11 pt.

Sample Form - NOTE: This is not a state form.