Worker's Compensation
ERGONOMIC EVALUATION REQUEST
ERGONOMIC EVALUATION REQUEST
ERGONOMIC EVALUATION REQUEST
Click on the icon on the left to submit an ergonomic evaluation of your work space. For questions, please contact Valerie Davis.
CLAIM FORMS
CLAIM FORMS
CLAIM FORMS
All of these forms are found in the red packets available to you at your school site. See the Office Manager.
Instructions: Download the form(s) below, and complete and submit to Valerie Davis in the Risk and Safety Department.
Please contact Valerie Davis with any questions at Valerie_Davis@pvusd.net or (831) 786.2100, ext 2960
- Employee incident report form (PDF)
- Supervisor's report of incident or injury (PDF)
- WC claim form DWC1 (Complete this form for all injuries requiring medical attention) (PDF)
- WC Pharmacy Card (Prescription Authorization for Work Related Injuries).pdf (PDF)
- PRIME advantage MPN complete written employee notification (español) (PDF)
- Physician-Predesignation.pdf (PDF)
- Physician-Predesignation-spanish.pdf (PDF)
- WC Pharmacy Card (Prescription Authorization for Work Related Injuries).pdf (PDF)
