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Workers Compensation

When an employee is injured at work, it is required that

they receive copies of all the forms below.

 

If Medical treatment is requested:

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

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If Medical treatment is not being requested:

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

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CONCENTRA - URGENT CARE

MAP & FORM

#1 PNG.png

MPN Acknowledgement 

#4 PNG.png

DWC-1 Form

#2 PNG.png

DWC - Time of Hire Notice

#5 PNG.png

MEDICAL PROVIDER NETWORK

PACKET. CORVEL

#3 PNG.png

Treatment Waiver Form

#6 PNG.png

Manager Training

Reporting Instructions

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