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Multiple Worksite Report State FormsThe form below is presented in PDF format. You will need Adobe Acrobat Reader to view the forms. For more information see how to view a PDF File. The Multiple Worksite Report is mandatory in the following states and territories: CA, CO, CT, GA, HI, IA, KS, LA, MD, ME, MN, MT, NC, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PR, RI, SC, UT, VA, VI, VT, WV. Click on the link below to download a blank Multiple Worksite Report form. Please complete the form and mail or fax it to the state that corresponds to the state in which your business is located.
Last Modified Date: March 21, 2025 |