Workers Compensation Forms and Policies

General

  1. Report of Injury to Employer
  2. Request for Mileage Reimbursement (PDF)
  1. Supervisor Instructions for Reporting Employee Injury-Illness
  1. WKC12 Form 2009 version (PDF)

City Hall

  1. City Hall Injury Illness Medical Service Order (PDF)
  1. Physician Notificiation Letter (PDF)
  1. Workers Compensation Information City Hall (PDF)

DPW

  1. Employee Return to Work Slip Non-Physician Appointments DPW (PDF)
  2. Injury and Illness Medical Service Order DPW (PDF)
  3. Physician Notification Letter DPW (PDF)
  1. Procedures for DPW Employees WC Appointments (PDF)
  2. Request for Mileage Reimbursement (PDF)
  1. Return to Work Form DPW (PDF)
  2. Worker Compensation Information DPW (PDF)

Fire

  1. FD-52 Physician Notification Letter Fire Department (PDF)
  2. Injury Illness Medical Service Order Fire Department (PDF)
  1. Request for Mileage Reimbursement (PDF)
  1. Worker Compensation Information Fire Department (PDF)

Health

  1. Employee Return to Work Slip Non-Physician Appointments Health Department (PDF)
  2. Injury Illness Medical Service Order Health Department (PDF)
  3. Physician Notification Letter Health Department (PDF)
  1. Report of Injury To Employer Health Department (PDF)
  2. Request for Mileage Reimbursement (PDF)
  1. Return to Work Form Health Department (PDF)
  2. Worker Compensation Information Health Department (PDF)

Library

  1. Employee Return to Work Slip Non-Physician Appointment Library (PDF)
  2. Injury Illness Medical Service Order Library (PDF)
  3. Physician Notification Letter Library (PDF)
  1. Report of Injury to Employer Library (PDF)
  2. Request for Mileage Reimbursement (PDF)
  1. Return to Work form Library (PDF)
  2. Worker Compensation Information Library (PDF)

Police

  1. Employee Return to Work Slip Non-Physician Appointments Police Department (PDF)
  2. ER Authorization Form-Aurora (PDF)
  3. Injury Illness Medical Service Order Police Department (PDF)
  1. Physician Notification Letter Police Department (PDF)
  2. Report of Injury to Employer Police Department (PDF)
  3. Request for Mileage Reimbursement (PDF)
  1. Return to Work Form Police Department (PDF)
  2. Worker Compensation Information Police Department (PDF)