The following are official PSWCP forms approved for use.
- Form A-1 – Request for Calculation and Certification of Award;
- Form 1 – Employee’s Notice of Injury / Claim for Continuation of Pay;
- Form 3 – Physician’s Report;
- Form 3RC – Annual Medical Recertification;
- Form 3A – Employee Statement of Medical History;
- Form 3M - Doctors Report of MMI PI
- Form 3S – Physician’s Evaluation
- Form 4 – Employee Authorization for Release of Medical Records
- Form 6 - Employee Authorization for Release of PSWCP Records
- Form CA7 - Claim for Compensation
- Form 7 - Employee Request for PSWCP File
- Form 8 – Employee Report of Earnings;
- Form 9 – PSWCP Hearing Request Form;
- Form 9A – PSWCP Appeal to CRO Form;
- Form 9E - Utilization Review or Hearing Request Form;
- Form CA10 – Request for Leave Restoration;
- Form 11 – Employee Request for Travel Reimbursement;
- Form 12 – Claimant Request for Permanent Disability Compensation;
- Form 13 - Request for Waiver or Challenge of Preliminary Determination on Overpayment
- Form 13F - Financial Statement Form
- Form 15 - Employee Representative Authorization Form
- Form 16 - Employee Change of Address
- Form 17 - Employment Verification Form