Seattle

WORK RELATED INJURY PROCEDURE

• Form 3 – Employee Report of Injury
• Form 4 – Worker_s Comp Fraud
• Form 5 – Consent for Release of Medical Information
• Form 6 – Employee Refusal of Medical Treatment Form

• Form 7 – WC Report Supplemental Questions
• Form 8 – Supervisor’s Report of Injury
• Form 9 – Accident Investigation Report temco

• Form 10- Root Cause and Prevention Analysis
• Form 11 – Witness Statement
• Form 12 – Temco Authorization
• Form 13 – Modified Duty Assignment Form