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* We recommend the First Report of Injury be submitted within 24-48 hours of employer’s knowledge or notice of an injury or claim to avoid penalties assessed by the Workers Compensation Board.
1. Employer’s First Report of Occupational Injury or Disease (WCB-1) (FIRST REPORT)
2. Supervisor’s Incident Report (ER-REPORT.doc)
3. Employee’s Incident Report (EE-REPORT.doc)
4. Limited Certificate…Medical Authorization (WCB-220) (MED-AUTH.pdf)
5. CMS (Centers for Medicare Services) Legal Documentation (CMS – INFO.pdf)
** Above forms must be emailed to Betti-Jeanne Bullock at email@example.com or faxed to (207) 620-7090.
Other forms that may be required/requested:
• Fringe Benefit Worksheet (WCB-2B) (FRINGE.pdf)
• Wage Statement (WCB-2) (WAGE.pdf)
• Mileage Reimbursement Form (msma-mileage-claims.doc)