Worker's Compesation Forms
Listed below are the Worker's Compensation Forms that are required by the Jefferson County Finance Office.
PLEASE NOTE: All attached forms are interchangeable for School and County employee’s unless otherwise noted.
Please "click" on the corresponding form as needed.
- #1A - First Report of Injury - Jefferson County School Employee
- #1B - First Report of Injury - Jefferson County Employee
- #2A - Employee's Choice of Physician - Jefferson County School Employee
- #2B - Employee's Choice of Physician - Jefferson County Employee
- #3 - HIPAA Medical Authorization
- #4 - Employee Accident Report
- #5 - Supervisor Accident Investigation Report
- #6 - Accident Witness Report
- Worker's Compensation Checklist