Skip to main content

Employee Declination of Workers Comp.

[featured_image]
Download
Download is available until [expire_date]
  • Version
  • Download 0
  • File Size 124 KB
  • File Count 1
  • Create Date September 9, 2022
  • Last Updated September 9, 2022

Employee Declination of Workers Comp.

Employee Declination of Workers Comp_Treatment REVISED 11.23.20

Employee Declination of Workers Comp.

If you do not want to seek treatment, please complete a work injury form (DWC-1) and sign the lower section of the Declination form. Submit both completed forms to HR. If you do not want to complete a DWC-1 form, complete both sections of the Declination form and submit to HR.