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01×29/2016 CAMBRIA COUNTY COMMONWEALTH OF PA Workers' Compensation Program: Designated Health Care Providers NOTICE TO EMPLOYEES IN CASE OF WORK-RELATED INJURIES If you suffer a work-related injury,

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1. Begin by downloading the Cambria Commonwealth of Pennsylvania PDF form from a reliable source or the official website. Make sure you have a PDF reader installed on your device.
2. Open the downloaded PDF form using your PDF reader.
3. Read the instructions provided at the beginning of the form carefully. These instructions will guide you on how to properly fill out the form to meet the requirements of the Commonwealth of Pennsylvania.
4. Start filling out the form by entering your personal information in the designated fields. This may include your full name, address, contact information, and any other required details.
5. Pay close attention to any specific sections or questions that require additional documentation or supporting materials. Make sure to attach or provide the necessary documents as requested.
6. Follow any additional instructions, such as signing and dating the form if required.
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9. If necessary, print out the completed form and submit it according to the instructions provided. This may involve mailing the form or delivering it in person to the appropriate office.

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1. Individuals who reside or have business dealings in Cambria County, Pennsylvania, may require the Cambria Commonwealth of Pennsylvania PDF form for various purposes.
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