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This document is intended for injured employees to report their accidents, details of their injuries, and to select their leave options following an injury on the job. It is a necessary form for processing

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How to fill out NORTH CAROLINA STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM EMPLOYEE STATEMENT AND LEAVE OPTIONS

01

Obtain the NORTH CAROLINA STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM EMPLOYEE STATEMENT AND LEAVE OPTIONS form from your supervisor or the HR department.

02

Fill in your personal information including your name, employee ID, and job title at the top of the form.

03

Provide details of the incident or injury that you are claiming. Include the date, time, and location of the incident.

04

Describe your injury or illness in detail, including any medical treatment received.

05

Indicate the type of leave options you wish to pursue, such as sick leave, family medical leave, or workers' compensation leave.

06

Sign and date the form at the bottom to certify that all information provided is true and accurate.

07

Submit the completed form to your supervisor or the designated HR representative as instructed.

Who needs NORTH CAROLINA STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM EMPLOYEE STATEMENT AND LEAVE OPTIONS?

01

Employees of the North Carolina state government who have been injured on the job.

02

Employees seeking to apply for workers' compensation benefits.

03

Employees needing to document their leave options following an injury or illness.

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What is NORTH CAROLINA STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM EMPLOYEE STATEMENT AND LEAVE OPTIONS?

The North Carolina State Government Workers' Compensation Program Employee Statement and Leave Options is a document that outlines the rights and options available to employees who are injured at work. It includes information about reporting procedures, compensation benefits, and available leave options during the recovery period.

Who is required to file NORTH CAROLINA STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM EMPLOYEE STATEMENT AND LEAVE OPTIONS?

All employees of the North Carolina State Government who sustain a work-related injury or illness are required to file the Employee Statement and Leave Options to ensure they receive the appropriate benefits and protections under the Workers' Compensation Program.

How to fill out NORTH CAROLINA STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM EMPLOYEE STATEMENT AND LEAVE OPTIONS?

To fill out the Employee Statement and Leave Options, an employee should complete the designated form by providing personal information, details about the injury, the date it occurred, and any medical treatment received. It's important to follow instructions provided on the form and submit it to the appropriate department or supervisor.

What is the purpose of NORTH CAROLINA STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM EMPLOYEE STATEMENT AND LEAVE OPTIONS?

The purpose of the Employee Statement and Leave Options is to inform employees about their rights under the Workers' Compensation Program, outline the procedure for reporting injuries, and detail the available leave options for employees as they recover from work-related injuries.

What information must be reported on NORTH CAROLINA STATE GOVERNMENT WORKERS' COMPENSATION PROGRAM EMPLOYEE STATEMENT AND LEAVE OPTIONS?

The information that must be reported includes the employee's name, contact information, job title, a description of the injury or illness, the date of the incident, any witnesses, and details about medical treatment received. Additionally, any leave taken or requested must be documented.

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