Workers’ Compensation Employee Statement Form

Supervisors should provide all injured employees with this form to complete the information concerning the accident or incident and the use of leave options for any time lost from work that may result from injury. The form should be completed in detail to give an accurate account of the case.

Area:
Administration and Finance
Department:
Office of Budget and Financial Planning
Audiences:
Employees,
Public
Contact Person:
Cathy Allsbrook-Graves