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Friday, April 19, 2024 -
WCC PDF Forms
| Form Name | Form Number |
|---|---|
| Arbitrator Submittal Form | Form 10297 |
| Audit Referral Form (06-2006) | DWC-AU-906 |
| Case Initiation Document | RU 101 |
| Declination Of Vocational Rehabilitation Services (1-1-90 - 12-31-93) | RU 107 |
| Denial of Vocational Rehabilitation Benefits (RU-500Y) | RU-500Y |
| Description Of Employees Job Duties | RU 91 |
| Finding and Order (Replacement QME Represented) | |
| Finding and Order (Replacement QME Unrepresented) | |
| Finding and Order RE: Second QME Panel (Unrepresented Case) | |
| Finding and Order RE:Second QME Panel (represented case) | |
| Glossary of workers' compensation terms for injured workers (07-2005) | Fact Sheet B |
| Glossary of workers' compensation terms for injured workers - Spanish (09-2005) | Fact Sheet B |
| Help in Returning to Work | 10133.2 |
| How to file a complaint with the Audit Unit (06-2006) | DWC-AU-905 |
| Initial Evaluation Summary | RU 120 |
| Mandatory Notices For Vocational Training & Return to Work | |
| Medical Mileage Expense Form (01-2009) | I&A mileage form |
| Nontransferable Training Voucher Form | DWC-AD10133.57 |
| Notice of Interruption or Deferral of Vocational Rehabilitation Services | |
| Notice of Interruption or Deferral of Vocational Rehabilitation Services (Spanish) | |
| Notice of offer of modified or alternate work (01-2003) | RU 94 |
| Notice Of Offer Of Modified Or Alternate Work [spanish] | RU 94s |
| Notice of offer of modified or alternative work - for injuries occurring on or after 01-01-2004 (08-18-2006) | DWC-AD 10133.53 |
| NOTICE OF OFFER OF REGULAR WORK (for injuries aft 1/1/05) | DWC-AD 10003 |
| Notice of Potential Eligibility (pre 1994) | RU-500W |
| Notice Of Potential Eligibility For Vocational Rehabilitation | DWC 500L |
| Notice of Potential Right to Supplemental Job Displacement Benefit | 10133.52 |
| Notice of Potential Right to Supplemental Job Displacement Benefit Form | |
| Notice of Potential Right to Supplemental Job Displacement Benefit Form (Spanish) | |
| Notice Of Termination Of Vocational Rehabilitation Services | RU 105 |
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