Forms & Brochures
Bill of Rights
Employee’s rights and responsibilities under Workers’ Compensation. This must be posted in conspicuous areas throughout the agency locations. (PDF, 71kb)
Employee Brochure
Explains the managed care organization and should be given to all employees. (PDF, 179kb)
Employee Handbook
Basic information for employees regarding work related injuries and frequently asked questions. (PDF, 69kb)
Employee Report
Employee’s report of an injury. (PDF, 23kb)
Fraud Notice
Penalty for Workers’ Compensation Fraud. (PDF, 975kb)
GA Activity Analysis
A brief, but detailed job description which should be completed on all employees. (Word, 24kb)
Incident Notice
Agency’s internal report of incidents not requiring medical attention. Do not report these to DOAS, unless medical is required. (PDF, 26kb)
Job Hazard Analysis
An analysis of a job to identify steps, hazards and corrective measures to be taken to prevent injury. (PDF, 30kb)
Leave Election
Choose the option of payment to be received when injured on the job. (PDF, 24kb)
Location Codes
Agency location identifier to be used when reporting injuries. (Excel, 139kb)
Medical Authorization
An employee’s consent for RMS to obtain medical records and information (PDF,51kb)
Mileage Form
Use this form to request reimbursement for mileage expenses associated with treatment of an injury. (PDF, 28kb)
Panel of Physicians
This MCO Panel must be posted in conspicuous places throughout the agency locations. (PDF, 1,385kb)
Reporting Instructions
Information needed in order to report an employee’s injury to DOAS reporting call center. (PDF, 28kb)
Supervisor Report
Sample report to be completed by supervisors for internal uses to document an injury. (PDF, 36kb)
Supervisor’s Guide
Basic information for supervisors regarding work related injuries and frequently asked questions. (Word, 138kb)
Wage Statement
Report 13 weeks of wages for an injured worker to DOAS. (PDF, 20kb)
Wallet Card
Provides information on what to do when you are injured and should be given to all employees. (PDF, 40kb)
Witness Report
Statement from witness to an injury. (PDF, 20kb)