Worker's Compensation
Claim Forms
(all these forms are found in red packets)
Click on the blue titles below to get the forms
(Complete this form for all incidents)
(Complete this form for all injuries requiring medical attention)
(Give to authorized doctor's office, 1st visit)
(List of authorized doctors for work related injuries)
- Flow Chart
- Notice to Employees
- Aviso a los empleados
- Predesignated Medical Provider
- WC Pharmacy Card
(Prescription authorization for work related injuries)
Instructions: Download form(s) above, complete and submit to Myrna Wight in the Human Resources Department.
Please contact Myrna Wight with any questions at Myrna_Wight@pvusd.net or (831) 786.2100, ext 2960
