PHYSICIAN  DESIGNATION  FORM

Downloadable Form in Acrobat Format

You have the legal right to designate your doctor to treat you for an injury that has occurred on the job!  You must first designate your treating physician by filling out the attached form and submit it to the employer prior to any on-the-job injury.  The form must be filed in 3-parts (original to the employer, copy to the union, and copy for employee).

If you are not familiar with this form, please contact your Shop Steward or Union Representative for instructions on filing this form with your Employer.