Oregon

WORK RELATED INJURY PROCEDURE

PDF Refused Medical Treatment Forms

• Form 1 – Employee’s Report of Injury
• Form 5 – Supervisor’s Report
• Form D – Refusal of Medical Treatment

PDF Sent to Medical Forms

• Form 801
• Form C – Auth. for Treatment
• Form 1 – Employee Report of Injury

Forms 4-8

• Form 4 – WC Supplemental Forms
• Form 5 – Supervisor Report
• Form 6 – Accident Root Cause
• Form 7 – Witness Statements
• Form 8 – Modified Duty Form

WC Claim Kit

• OR Claim Kit