Workers' Comp. Forms

Accident*
Form A1 *
PECD form 1*
PECD form 2*
Form N* **
Unsafe Conditions
First Aid
Form H
Form P
Form S
Inspection
Mileage

Fill out first five forms (with *) to left and fax to 3584. Send originals via campus mail to Environmental Health & Safety.

**PLEASE HAVE EMPLOYEE INITIAL & DATE THE SECOND PAGE OF FORM N AND KEEP A COPY.