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City of Ashland, Oregon / Administration / Personnel / WORKERS' COMPENSATION / Workers' Compensation Claim Form 801

Workers' Compensation Claim Form 801

If medical treatment is sought for the injured employee, Form 801 is required to be filled out by the employee, then turned in to Personnel for completion. Personnel will submit the form to Health Future LLC for evaluation and determination of acceptance or denial. Click below to download the form.




Download File
Fillable-801 Claim Form- City of Ashland.pdf

(504.5KB)
 

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