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CCU Employee WC FormsStatementSGWCP2 06/06NORTH CAROLINA STATE GOVERNMENT WORKERS\' COMPENSATION (WC) PROGRAM EMPLOYEE STATEMENT, LEAVE OPTIONS & MEDICAL AUTHORIZATION/RELEASE FORM Supervisors should

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How to fill out workers compensation employee statement

01

Step 1: Obtain the workers compensation employee statement form from your employer or human resources department.

02

Step 2: Fill out your personal information including your name, address, phone number, and social security number.

03

Step 3: Provide details about your injury or illness including when and where it occurred.

04

Step 4: Describe the circumstances surrounding the incident that led to your injury or illness.

05

Step 5: Sign and date the form before returning it to your employer.

Who needs workers compensation employee statement?

01

Employees who have been injured or become ill at work and are seeking workers compensation benefits.

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What is workers compensation employee statement?

Workers compensation employee statement is a form that employees fill out to report a work-related injury or illness.

Who is required to file workers compensation employee statement?

All employees who have suffered a work-related injury or illness are required to file a workers compensation employee statement.

How to fill out workers compensation employee statement?

To fill out a workers compensation employee statement, employees must provide details about their injury or illness, how it occurred, and any medical treatment they have received.

What is the purpose of workers compensation employee statement?

The purpose of workers compensation employee statement is to report work-related injuries or illnesses so that employees can receive appropriate medical treatment and compensation.

What information must be reported on workers compensation employee statement?

Information that must be reported on a workers compensation employee statement includes details about the injury or illness, how it occurred, and any medical treatment received.

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