Practitioner's Report on Accident or Industrial Disease in Lieu of Testimony

Document Number:  WKC-16-B-E

Description:  To be used for litigation.

Comments:  This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word).  It can be printed and completed by hand.

Content Contact:  Kathy Froehlich

Document Attachments:

WKC-16-B-E (Electronic Version - Word/79 KB)

WKC-16-B (Print Version - pdf/14 KB)

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

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Updated September 28, 2011