Forms
Download WorkConnections forms
These forms are viewable in Adobe Acrobat Reader. Click here to download the reader from the Adobe Web site.
- Authorization to Release Patient Information
- Illness or Injury Report Form
- Health Care Provider Report Form
- Mileage Reimbursement
How to complete and submit forms
to WorkConnections
- Department fills out form and faxes a copy to WorkConnections at (734) 936-1913
- Department faxes a copy of authorization to Occupational Health Services Program (OHS)
(formerly MWorks) at (734) 763-7405 - Complete each form in its entirety
- Keep a copy for your records
Coming soon:
The capability to submit your WorkConnections forms through this website.
Fax forms to:
(734) 936-1913