Volume 8: Form 381

Question 1

An employee must submit a Form 381 __________

Answer 1

at the time of injury

Question 2

An employee must submit a Form 381 even if_________

Answer 2

They decline treatment

Question 3

An employee may claim workers comp and seek medical attention for ______ after the date of injury

Answer 3

1 year

Question 4

If the supervisor does not agree with the employees report – or has additional comments they must be___________

Answer 4

attached to Form 381

Question 5

Form 381 should not be used to report_________

Answer 5

Exposures

Question 6

Form _______ should be used to report exposures

Answer 6

382

Question 7

If exposure results in injury or illness ______ forms must be competed

Answer 7

both

Question 8

If an employee does not seek medical treatment the _______ must be filled out

Answer 8

Medical Treatment Declination portion of Form 381

Question 9

By signing the Medical Treatment Declination, the employee ______ benefits

Answer 9

Does not waive

Question 10

Completed Form 381 must be sent via ______ or ______

Answer 10

US Mail or in person

Question 11

Completed Form 381 must be delivered to ______

Answer 11

RTW

Question 12

Completed Form 381 must be sent within_______

Answer 12

24 hours