Empire Pacific Risk Management, Inc.
5300 Meadows Road, Suite 200
Lake Oswego, OR 97035
Phone: (503) 968-6300
Fax: (503) 968-6305

Download Form 801: Report of Job Injury or Illness

• English PDF format
• Spanish PDF format
• English Word format
• Spanish Word format

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Erin Nielsen, ARM
Claims Manager
erin.nielsen@empirepac.com


Rhonda Goodell
Senior Claims Examiner
rhonda.goodell@empirepac.com


Kim Hoang
Medical Only Claims Examiner
kim.hoang@empirepac.com