- Version
- Download 180
- 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.
