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Get MI WC-100 2011

Sted above in space 54 WC-100 (Rev. 10/ ) Front If you are using this form as a replacement for the Form 301 to document the specifics of an injury or ill ness for purposes of compliance with the work-related injury and illness logging requirements, follow the instructions in Section A only. If you are using this form to report a workers’ compensation injury, follow the instructions in Section A and B. Section A This form can be used in lieu of the MIOSHA Form 301, Injury and Illness Incid.

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