Workers comp/insurance forms

This area of the employee section deals with health and insurance-related issues. Please click on any of the files below to access important forms. If you have any questions about how to use this part of the website, please contact Jeff Keeling at 753-0393 or 773-6438.

For workers comp information, call Michelle Stewart at the Washington County Highway Department: 753-1714. Fax number: 753-1710. After hours call 384-7034.
 

If you're injured on the job:
 
If you will be seeking medical attention, you'll need to do the following: Complete paperwork as accurately and quickly as possible and forward to Michelle Stewart. Timeliness is important, and all claims must be reported to our insurance carrier within 48 hours of the injury. If the employee  is unable to complete the form, the supervisor needs to complete it and forward to Michelle. The "employee information form" is for the employee to take to the doctor's office (it contains all contact information). It is helpful if the doctor's office returns the form or a copy to the employee so the employee has Michelle's contact information. Employees also need to complete a "First report of injury" form.
AttachmentSize
workers_comp_claim_ticket.pdf415.85 KB
physician_panel.pdf177.69 KB
first_report_of_work_injury.pdf211.99 KB