Safety and Worker’s Compensation Information

Safety and Worker’s Compensation Forms

• Form 140

Equipment Accident and Property Damage Report

• Form I-1

Incident Investigation Form – Employee Statement

• Form I-2

Incident Investigation Form

• Form 19

Employer’s Report of Injury

• Form 19-S

Supplemental Report of Injury

• MARTW

Medical Authorization/Return to Work

• FR-26

Worker’s Compensation Form – Employee Use of Leave Options Election

• WC-93RI

Worker’s Compensation Form – Release of Information

• WC-94RT

Worker’s Compensation Form – Refusal of Treatment

• Form 25P

NC Industrial Commission – Itemized Statement of Charges for Drugs

• Form 25T

NC Industrial Commission – Itemized Statement of Charges for Travel

• SUMLOG

Field Incident Summary Log For: Tick Bites

• OSHA Forms 300,300A, 301

Work Related Injuries and Illnesses: Log Report, Summary Report, Incident Report