Claimant Information Packet: Information for people who will be making a claim
Volunteer Ambulance Worker Accident Report (VAW-3): Volunteer use this form
to report an injury to your Ambulance Squad
Volunteer Firefighter Accident Report (VF-3): Volunteer use this form to
report an injury to your Fire Department
Limited Release of Health Information (C-3.3): Employees complete this form
and turn in with the accident report form
Medical Authorization: Employees complete this form and turn in with
the accident report form
Pharmacy Benefits: Employees use these forms to obtain Pharmacy items
related to your injury.
Encounter Form: Employees take this form with you to your
Employers Report of Injury (C-2F) - Volunteer Fire Department Chiefs
and Volunteer Ambulance Squad Captains use this form to report volunteer injuries to the
Self Insurance Department.