top of page

Workers Compensation

Clipboard.png

DWC 1 form

When an employee is injured at work, they must receive copies of all the forms below.

 

If Medical treatment is requested:

Forms 1, 2, and 4 must be completed and returned to HR. 

​

If Medical treatment is not being requested:

Forms 2, 4, and 6 must be completed and returned to HR.

​

​​​​

​

CONCENTRA- URGENT CARE MAP AND FORM

MPN Acknowledgement 

Right to Workers Comp

MEDICAL PROVIDER NETWORK

PACKET. CORVEL

Treatment Waiver form

#1 PNG.png
#4 PNG.png
#3 PNG.png
#5 PNG.png
#2 PNG.png
#6 PNG.png
bottom of page