Employee Acknowledgement of Alliance Direct Contracting Program
Employees must sign this form acknowledging they understand how to receive health care in the Political Subdivision Workers’ Compensation Alliance. Available in English and Spanish.
Employees must sign the form when initially notified about Alliance requirements and again if they are injured at work. The form is available in English and Spanish.
You'll need to log in to keep reading.
This information is exclusively for members with Workers' Compensation access.
Log in Request AccessOther Resources You May Also Like...
Bona Fide Offer of Employment Template
When the doctor clears your injured employee to return to work, use this template to issue a bona fide offer of employment that meets state requirements.
Employee Incident Investigation Worksheet
Uncover and correct the root causes of workplace accidents to reduce the risk of them happening again.
Hurricane Safety Checklist
Follow these tips to protect staff, students, property, and vehicles if a hurricane threatens or hits your community.
Property Claim Reporting Guide
Explains which information employers should collect before logging in to report a property claim.