Workers Compensation

FORMS

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Admittance Form (3-WC)
This form is to be filled in by the supervisor and taken to the Center for Occupational Health by the employee for the first visit only.

Employee Incident Report  (5-WC)
To be filled in by employee and supervisor within 24 hours of an accident or injury.

OSHA Form 301
This form helps the employer and OSHA develop a picture of the extent and severity of work-related incidents, file this report if the doctor has you off work or on restricted duty due to the injury.

 

Adobe Acrobat (PDF) Reader download page:
http://www.indstate.edu/oit1/readers/acrobat/