Health and Safety Forms


*Please note: most of these forms are for reference only. You must contact the Health and Safety Department for an actual copy.

Forms
ADA Form A - Employee Disability Accommodation Request
ADA Form B - Physician's Certificate
ADA Form C - Employee Disability Accommodation Response (Supervisors)
ADA Form D - Accommodation Results
DMV Form - Cart Safety Rules
DMV Form - Driver Data Form
Ergonomics Procedures - GCCCD
Ergonomic Self Evaluation Form
Ergonomic Assessment Request
Ergonomic Equipment Guidelines
Ergonomic Equipment Selection List
Property & Casualty - Claim Against GCCCD Form
Safety - Record of Employee Safety Training
Workers' Compensation - District Injury/Illness report
Workers' Compensation - Employee Claim form, California DWC
Workers' Compensation - Guidelines, California DWC
Workers' Compensation - Instructions for Filing a Claim - Quick Reference
Workers' Compensation - Map to Concentra Facilities
Workers' Compensation - Map to KPOJ Facilities
Workers' Compensation - Predesignation Form (DWC Form 9783)
Workers' Compensation - Worker Comp Benefits
Workers' Compensation - First Fill Prescription Card
Workers' Compensation - Declination of Treatment (If Declining Medical Treatment)