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Get IOD Package - TWU Local 100 - Twulocal100

Ployee: / Complete this form upon occurrence of injury or recurrence of injury on duty and make three (3) photocopies. Complete the Department Section on front side of form, Employee s Section if applicable, and Investigation Form on reverse side. FAX BOTH SIDES OF FORM TO Workers Compensation Unit 718-694-3281/3807 and to System Safety (646) 252-5793. Send original within two business days to Workers Comp., 130 Livingston Street, 10th floor. Send copy to the Dept. Injury Reporting Uni.

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