Get Kwc97 - Interactive.pdf - Entzlaw

Filling out the Kwc97 - Interactive.pdf form is an essential process for requesting workers' compensation records. This guide will provide you with clear and precise instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click the 'Get Form' button to obtain the Kwc97 - Interactive.pdf form and open it in your preferred editor.
2. Begin by entering the requestor's name in the designated field. Ensure that this is the name of the individual making the request.
3. Fill in the phone number in the next field. This number should be where you can be reached for any clarifications or follow-ups.
4. Next, provide the company or entity's name requesting the records. If you are filing as an individual, you may leave this blank.
5. Input the fax number in the corresponding field, if applicable. This information is optional but can facilitate communication.
6. Enter the full address, including city, state, and zip code. This should be the address of the requestor.
7. In the 'Worker’s Name' section, write the full name of the individual whose records you are requesting.
8. Provide the worker’s social security number in the designated space. This is a mandatory requirement for processing the request.
9. Indicate which records you are seeking by checking the appropriate boxes. This could include accident report summaries or docket summaries.
10. Specify the date of the accident if applicable to your request.
11. Next, classify yourself or your organization by filling out either category I or II, according to your relationship to the worker.
12. If applicable, provide the type of job conditionally offered to the individual in the specified section.
13. The worker must sign and date the release section to authorize the records to be sent to the requestor.
14. The requestor must then sign and date the certification statement ensuring the truthfulness of the provided information.
15. Finally, review all entries for accuracy. After confirming that the form is correctly filled, you can save your changes, download, print, or share the completed form.

Complete your request for workers' compensation records online today!