Get Company Authorization Form - Ingalls Health System - Ingalls

Filling out the Company Authorization Form is an essential step for employees of Ingalls Health System who need to document workplace injuries or treatments. This guide provides a systematic approach to completing the form accurately and efficiently, ensuring that all required details are included.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the form, opening it in the designated editor.
2. Enter the date at the top of the form, marking when the form is being filled out.
3. In the ‘Employee Name’ section, print your full name clearly in the space provided.
4. In the ‘Company Name’ section, print the name of your employer as it appears in official documentation.
5. Fill in the ‘Company Address,’ ensuring all details are accurate for proper identification.
6. Provide the ‘Company Phone’ number for contact purposes.
7. In the ‘Injury Treatment’ section, describe the nature of the injury in the space provided.
8. Ensure you enter the ‘Date of Injury,’ which is a required field for the form.
9. Detail the ‘Work Comp Carrier’ and claim number, if applicable, to assist with workers' compensation processing.
10. Select the type of ‘Physical Examination’ needed by checking the appropriate box or boxes.
11. In the ‘Position Offered’ field, print the title of the position associated with this authorization.
12. Indicate if drug or alcohol testing is required by checking all relevant options.
13. State the reason for testing by checking the corresponding options in the ‘Reason for Testing’ section.
14. In the ‘Transportation’ section, check either ‘One Way’ or ‘Round Trip’ based on the transportation needs.
15. In the ‘Company Authorization By’ field, print the name of the authorized person at the company.
16. Fill in the contact phone number of the person authorizing the form.
17. After completing all sections, review the form for any errors and make necessary corrections.
18. Once confirmed, save the changes, download, print, or share the completed form as required.

Complete the Company Authorization Form online today to ensure timely processing of your workplace needs.