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Forms, Requests and Resources

First Report of Injury - This form is required by law if the employee missed more than one day of work due to the injury or if the medical bills exceed $2,000. Please fax or mail this form immediately to our claims manager.

Medical Treatment Report

Request a Loss Run

Posted Panel Document

Tennessee Posting Notice

Average Weekly Wage Worksheet

Mileage Reimbursement Form

Form C42G for Governmental Entities

Supervisors Incident Report

Workplace Posters

Brentwood Services Administrators, Inc./ TAASIT

P.O. Box 1125

Brentwood, Tennessee 37024-1125

Toll Free 800-524-0604

Telephone 615.263.1300

Fax 615.263.1301   

Participant Forms

(Under Development)

Application for Group Participation

Notice & Acknowledgement

Indemnity Agreement and Power Attorney

Tennessee Automotive Association Self Insurers' Trust