Workers Compensation Resources

How to use this page

Respond to an incident in three steps.

Use this page when an employee reports a work-related injury, illness, or related incident. Follow the checklist in order, then download the physician panel that matches the employee’s work location.

Start checklist Find physician panel

Incident Response Checklist

Manager and supervisor action list.

Complete each step in order. Download the linked forms as you go.

1
Manager / Supervisor instructions

Review the checklist and supervisor instructions as soon as you are notified of an incident.
- WC Checklist — Manager / SupervisorPDF · Download
- Workers Comp Instructions for SupervisorsPDF · Download
2
Supervisor completes these forms

Document the incident and authorize medical treatment. Use a state form only when required.
- Incident ReportPDF · Download
- Medical Treatment AuthorizationPDF · Download
- State Specific FormSee State Specific Claim Forms below if applicable.
3
Provide this packet to the employee

Give the employee instructions, the correct physician panel for their work location, and the remaining authorization forms.
- Workers Comp Instructions for EmployeesPDF · Download
- Physician PanelFind the panel below based on the employee’s work location.
- MANCON PanelPDF · Download
- Medical Treatment AuthorizationPDF · Download
- Physician Return to WorkPDF · Download
- Drug Screen Custody and Control FormObtain from HR if applicable.
- Patient Authorization to Release InformationPDF · Download
- State Specific Claim FormOnly if listed in the State Specific section below.
4
Other supporting forms

Add witness statements or police reports when they apply to the incident.
- Witness StatementPDF · Download
- Police ReportsAttach if applicable.

Physician Panels

Choose the panel for the employee’s work location.

128 location panels across MANCON sites. Filter by state or search by site name.

Virginia

49 panels

State Specific Claim Forms

Required only in listed states.

If your work location is listed here, download the form when available or contact HR.

Alaska Contact HR

Arizona Contact HR

Arkansas Contact HR

California Contact HR

Kansas PDF Illinois PDF

Maryland Contact HR

North Dakota Contact HR

Ohio Contact HR

Texas Contact HR

Washington DC Contact HR

Wyoming Contact HR

Safety Training

Materials for managers and supervisors.

Download the training sign-in sheet. Contact HR for additional safety training materials.

Safety Training Sign-In Sheet Email HR 757-457-9550

Workers Compensation

Respond to an incident in three steps.

Manager and supervisor action list.

Choose the panel for the employee’s work location.

California

Connecticut

Delaware

District of Columbia

Florida

Hawaii

Idaho

Maine

Massachusetts

Michigan

North Carolina

New Jersey

New York

Ohio

Pennsylvania

South Carolina

Texas

Virginia

Required only in listed states.

Materials for managers and supervisors.