Workers' Compensation

 

Employee

  1. Workers’ Compensation Claim Form (DWC 1) This form is completed and signed for INJURY claims only.  Reporting Incident or First Aid events only complete the Supervisor's Report of Incident or Injury with your supervisor.
  2. Medical Panel - Medical provider list for INJURY claims.
  3. Treatment Referral & Medical Authorization - Authorization for treatment for INJURY claims.
  4. PRIME Covered Employee Notification of Rights in English | en Español
  5. Personal Physician Designation: Rules | Form

Manager and Supervisors

  1. Reporting Procedures for Work Related Injuries
  2. REQUIRED: Workers’ Compensation Claim Form (DWC 1) - Required for INJURY claims.
  3. REQUIRED: Supervisor’s Report Of Employee Incident Or Injury - Required for all INCIDENT, FIRST AID or INJURY claims.
  4. REQUIRED:  Supervisor's Supplemental Questionnaire - Required for all INCIDENT, FIRST AID or INJURY claims.
  5. OPTIONAL:  Questionable Workers’ Compensation Injury Information Form

Ergonomics