Archives: ULC Forms

152 Appointment of Counsel

152 Appointment of Counsel
(optional)

024 Medical Care Provider

024 Medical Care Provider

025 Industrial Accident Claim

025 Industrial Accident Claim
– Form Instructions

113b Summary of Medical Record – Occupational Exposure

113b Summary of Medical Record – Occupational Exposure
(or you may submit actual medical records supporting your claim)

026 Occupational Disease Claim

026 Occupational Disease Claim
– Form Instructions

113a Summary of Medical Record – Industrial Accident

113a Summary of Medical Record – Industrial Accident
(or you may submit actual medical records supporting your claim)

308 Authorization to Release Medical Records (10 Years)

Form 308 - 15 years
308 Authorization to Release Medical Records (10 Years)

001 Industrial Accident Claim

001 Industrial Accident Claim
– Form Instructions