In observance of Thanksgiving, WCC offices will be closed on Thursday, November 24, 2022.

Worksheets

 

link opens in new browser tab  Mileage Worksheet

PDF File:  1 page; Last revised March 17, 2006
 

Mileage Worksheet for Medical Treatment - Examination - Physical Therapy - Laboratory Test

Although not an official Commission form, we provide this worksheet to injured employees who might need such a worksheet to report mileage incurred due to workers’ compensation-related medical appointments.

[NOTE: For complete information regarding this, refer to the    link opens in new browser tab  Info Packet and see also Public Act 01-33 for up-to-date mileage reimbursement rate information.]

 


 

link opens in new browser tab  Record of Employment Contacts

PDF File:  1 page; Last revised July 8, 2005
 

Record of Employment Contacts

Although not an official Commission form, we provide this worksheet to injured employees who might need such a worksheet to report contacts with employers during a job search while the employee is out on workers’ compensation.

[NOTE: For complete information regarding this, refer to the    link opens in new browser tab  Info Packet]

 


 

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The Workers' Compensation Commission's recommendation of Adobe's free Adobe Acrobat Reader software application is based solely on technical considerations inherent in the PDF files this agency produces, and does not constitute an endorsement of Adobe Software as a company or of its commercially-available products. There are a multitude of free and commercial software applications offered by various software makers that are capable of opening and displaying our PDF documents, but only the Adobe Acrobat Reader application makes full and accurate use of the capabilities we have built into our documents; the agency has found over a period of many years that the Adobe Acrobat Reader provides the best, most trouble-free experience using this Commission's PDF files.