Injured Workers Forms

Injury Reporting Kit
Click here for entire package

Individual forms:

• Claims Filing Procedure
• Options for Filing
• Employee Instructions
• Contact Information
• First Report of an Injury, Occupational Disease or Death Form

Other Forms:

• CHS Operations
• Employee's Report of Incident and Back Injury Form
• Employee's Report of Incident and Injury Form
• Employer ID Cards
• First Report of an Injury, Occupational Disease or Death Form
• Industrial Injury Fact Sheet Form
• MCO vs. TPA
• Medical Bill Resolution
• Occupational Disease or Illness Report Form
• Physician Referral Form
• Physician Selection
• Preferred Provider Form
• Statement of Witness to Accident Form
• Verification of Receipt Form