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WCC PDF Forms

Form NameForm Number
Arbitrator Submittal FormForm 10297
Audit Referral Form (06-2006)DWC-AU-906
Case Initiation DocumentRU 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 DutiesRU 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 Work10133.2
How to file a complaint with the Audit Unit (06-2006)DWC-AU-905
Initial Evaluation SummaryRU 120
Mandatory Notices For Vocational Training & Return to Work
Medical Mileage Expense Form (01-2009)I&A mileage form
Nontransferable Training Voucher FormDWC-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 RehabilitationDWC 500L
Notice of Potential Right to Supplemental Job Displacement Benefit10133.52
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 ServicesRU 105

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