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department avatarWorkers Compensation Claims

Workers Compensation Forms

C-1 -- Notice of Injury or Occupational Disease

C-4 -- Employee’s Claim for Compensation

D-1 -- Informational Poster

D-2 -- Brief Description of Your Rights and Benefits

D-12a -- Request for Hearing

D-26 -- Application for Reimbursement of Claim Related Travel Expenses

CCSD Leave Choice Option Form

Provider Map

Pharmacy Benefits Poster