Get the free CCFORM5 WORKERS COMPENSATION COMMISSION 1915 NORTH STILES AVENUE STE 231 OKLAHOMA CI...
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CCFORM5 WORKERS COMPENSATION COMMISSION 1915 NORTH STILES AVENUE STE 231 OKLAHOMA CITY, OK 73105 SEND COPIES TO: 1 Employee/Claimant 1 All Other Parties of Record Revised 2216 THIS SPACE FOR COMMISSION
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How to fill out ccform5 workers compensation commission
How to fill out ccform5 workers compensation commission:
01
Obtain a copy of ccform5 from the Workers Compensation Commission website or office.
02
Start by entering your personal information in the designated fields, including your name, address, and contact information.
03
Provide your employer's details, such as their name, address, and contact information.
04
Fill in the date of your injury or illness and provide a detailed description of what happened.
05
Indicate the body parts affected by the injury or illness and describe the symptoms or conditions experienced.
06
If you sought medical treatment, indicate the healthcare provider's name, address, and treatment received.
07
Enter any sick leave or other compensation received as a result of the incident.
08
Sign and date the form, certifying the information provided is accurate and complete.
09
Submit the form to the Workers Compensation Commission according to their instructions.
Who needs ccform5 workers compensation commission:
01
Employees who have suffered a work-related injury or illness and wish to file a workers compensation claim.
02
Employers who need to report an employee's work-related injury or illness to the Workers Compensation Commission.
03
Healthcare providers who have treated a patient for a work-related injury or illness and need to submit relevant information to the Workers Compensation Commission.
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