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Worker's Compensation Form
Click here to download the form for reporting a workers compensation claim. Once you have filled out and completed the form, email the completed form to HR@grapetree.com or fax it to (888) 678-4077.
If the state where you were injured differs from your home address, please use the following guide to determine which State FROI form to use:
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State hired = Iowa
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State you live ___________________
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State injured ___________________
Choose the state that has 2 matches above. If all 3 responses are different, then choose the state you would anticipate the majority of
medical care to occur.
![Map Outline.png](https://static.wixstatic.com/media/42446d_ed3348d68163435a97b6804d1c0cd2af~mv2_d_3203_1960_s_2.png/v1/fill/w_977,h_596,al_c,q_90,usm_0.66_1.00_0.01,enc_auto/Map%20Outline.png)
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