Survey Respondents

How to Request a Fillable Survey Form

To receive a fillable PDF version of the survey, please send an e-mail to your State (addresses listed below). This is the standard survey form for reporting your work-related injuries and illnesses to the Bureau of Labor Statistics. Please include your establishment ID in the subject line of your e-mail request. You will receive a fillable version of the survey along with pertinent instructions via e-mail.

State Code State Name Email requesting PDF Form
01 Alabama SOII-Alabama@idcf.bls.gov
02 Alaska SOII-Alaska@idcf.bls.gov
04 Arizona SOII-Arizona@idcf.bls.gov
05 Arkansas SOII-Arkansas@idcf.bls.gov
06 California SOII-California@idcf.bls.gov
08 Colorado SOII-Colorado@idcf.bls.gov
09 Connecticut SOII-Connecticut@idcf.bls.gov
10 Delaware SOII-Delaware@idcf.bls.gov
11 District of Columbia SOII-DC@idcf.bls.gov
12 Florida SOII-Florida@idcf.bls.gov
13 Georgia SOII-Georgia@idcf.bls.gov
66 Guam SOII-Guam@idcf.bls.gov
15 Hawaii SOII-Hawaii@idcf.bls.gov
16 Idaho SOII-Idaho@idcf.bls.gov
17 Illinois SOII-Illinois@idcf.bls.gov
18 Indiana SOII-Indiana@idcf.bls.gov
19 Iowa SOII-Iowa@idcf.bls.gov
20 Kansas SOII-Kansas@idcf.bls.gov
21 Kentucky SOII-Kentucky@idcf.bls.gov
22 Louisiana SOII-Louisiana@idcf.bls.gov
23 Maine SOII-Maine@idcf.bls.gov
24 Maryland SOII-Maryland@idcf.bls.gov
25 Massachusetts SOII-Massachusetts@idcf.bls.gov
26 Michigan SOII-Michigan@idcf.bls.gov
27 Minnesota SOII-Minnesota@idcf.bls.gov
28 Mississippi SOII-Mississippi@idcf.bls.gov
29 Missouri SOII-Missouri@idcf.bls.gov
30 Montana SOII-Montana@idcf.bls.gov
31 Nebraska SOII-Nebraska@idcf.bls.gov
32 Nevada SOII-Nevada@idcf.bls.gov
33 New Hampshire SOII-NewHampshire@idcf.bls.gov
34 New Jersey SOII-NewJersey@idcf.bls.gov
35 New Mexico SOII-NewMexico@idcf.bls.gov
36 New York SOII-NewYork@idcf.bls.gov
37 North Carolina SOII-NorthCarolina@idcf.bls.gov
38 North Dakota SOII-NorthDakota@idcf.bls.gov
39 Ohio SOII-Ohio@idcf.bls.gov
40 Oklahoma SOII-Oklahoma@idcf.bls.gov
41 Oregon SOII-Oregon@idcf.bls.gov
42 Pennsylvania SOII-Pennsylvania@idcf.bls.gov
43 Puerto Rico SOII-PuertoRico@idcf.bls.gov
44 Rhode Island SOII-RhodeIsland@idcf.bls.gov
45 South Carolina SOII-SouthCarolina@idcf.bls.gov
46 South Dakota SOII-SouthDakota@idcf.bls.gov
47 Tennessee SOII-Tennessee@idcf.bls.gov
48 Texas SOII-Texas@idcf.bls.gov
49 Utah SOII-Utah@idcf.bls.gov
50 Vermont SOII-Vermont@idcf.bls.gov
51 Virginia SOII-Virginia@idcf.bls.gov
52 Virgin Islands SOII-VirginIslands@idcf.bls.gov
53 Washington SOII-Washington@idcf.bls.gov
54 West Virginia SOII-WestVirginia@idcf.bls.gov
55 Wisconsin SOII-Wisconsin@idcf.bls.gov
56 Wyoming SOII-Wyoming@idcf.bls.gov

Last Modified Date: December 29, 2010

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