Forms
Workers' Compensation Accident Packet:
- WC Employee Instructions
- WC Supervisor Instructions
- WC Medical Restriction Form
- WC Form 1: Accident Report
- WC Form 2: Prior Health History
- WC Form 3: Authorization for Release of Health Information
- WC Form 4: Notice to Employees Receiving WC Benefits
- WC Form 5: Administration Report
- WC Form 6: Treating Physicians WC Report
Volunteer Firefighters' Accident Packet:
- VF Instructions
- VF Accident Report
- VF Form 2: Authorization for Release of Health Information
- VF Form 3: Notice To Claimants Receiving WC Benefits
- VF Form 4: Administration Report
- VF Form 5: Treating Physicians VF Report
For Employers (Departments/Towns/Villages):
For Employees:
- Exit Questionnaire
- Current Status Statement
- Insurance Premium Waiver Application Form
- Insurance Requirements Questionnaire Form
Copyright
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