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Workplace Injury Forms

Workplace Injury Forms

The SDRMA Workplace Injury Packet below includes the following forms:

  1. Employee Acknowledgment of Receipt of Workplace Injury Packet & Declining First Aid Injury Treatment
  2. Supervisor Incident Report Form
  3. Declination of Medical Treatment Form
  4. Declination of Medical Treatment Incident Report Form
  5. Employee Acknowledgment of Receipt of Workplace Injury Packet & First Aid Injury with Treatment Form
  6. Employee Acknowledgment of Receipt of Workplace Injury Packet & Major Injury/Illness with Treatment Form
  7. Employee Incident Report Form
SDRMA Workplace Injury PacketSDRMA Employer's Report of Occupational Injury or Illness Form 5020Workers' Compensation Claim Form DWC 1 & Notice of Potential Eligibility