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. 

For workers comp information, contact the Benefits Coordinator - Michelle Stewart:  423-753-1822. Fax number: 423-913-8304. After hours call 423-384-7034.

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 Ms. Stewart. 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 Ms. Stewart's contact information. Employees also need to complete a "First report of injury" form.
panel_july_2014.pdf186.26 KB
first_report.pdf231.65 KB
asc-washingtonco.pdf430.68 KB