Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
DWD-DWC Form WKC-19606-P – Worker’s Compensation: Notice to Injured Workers and Employers (Versión en Español)
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Reports
DWD-DWC Form WKC-12-E – Employer’s First Report of Injury or Disease (Versión en Español)
DWD-DWC Form WKC-13-A-E – Wage Information Supplement
Incident Investigation Report (Versión en Español)
Supervisor’s Report of Employee Incident (Versión en Español)
Witness Statement of Injury or Incident (Versión en Español)
Instructions for Injured Worker Handouts
Injured Workers First Fill Prescription Form (Versión en Español)
DWD-DWC Form WKC-9488-E – Voluntary and Informed Consent for Disclosure of Health Care Information (Versión en Español)
DWD-DWC Form WKC-12698-E – Statement of Self-Restriction to Part-Time Work (Versión en Español)
Consent and Authorization for Release of Information Form (Versión en Español)
Request for Medical History Form (Versión en Español)
Direct Deposit Authorization Form (Versión en Español)
Instructions for Informational Documents
Omaha National Contact Information
Reduce Your Workers Compensation Costs
DWD-DWC Brochure WKC-7317-P – Wisconsin Worker’s Compensation Law – Employer Facts
Instructions for General Forms
Request for Subrogation Waiver
Form ERM-14 – Confidential Request for Ownership Information
Company Contacts Verification
