Get Dp 2002 Form

The Dp 2002 Form is essential for notifying your department of your election regarding the charge against your annual and/or sick leave balances due to an injury sustained in the performance of your official duties. This guide will provide step-by-step instructions to help you complete the form accurately online.

Follow the steps to fill out the Dp 2002 Form correctly.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the name of the injured employee in the designated field, as asked at the top of the form.
3. Next, input the name of the city department or agency where the injured employee is employed.
4. Select one option from the choices provided regarding how you elect the charge against your leave balances.
5. If you choose Option 1, ensure you understand the conditions attached and make sure your accrued leave balances are adequate.
6. If you choose Option 2, confirm your decision to receive Workers’ Compensation benefits without charges against your leaves.
7. After selecting the desired option, provide the injured employee’s signature to validate the form.
8. If applicable, complete the shaded section for an authorized designee to sign on behalf of the injured employee.
9. Fill in the address of the authorized designee and ensure their signature is recorded if they are signing on behalf of the employee.
10. Lastly, include the names and addresses of the witness who verifies the information by signing the form.
11. Once all fields are completed, review the form for accuracy. You may then save changes, download, print, or share the completed form as needed.

Complete your Dp 2002 Form online today to ensure proper processing of your request.