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Required DOE forms to file for Workers' Compensation

If you are filing for workers’ compensation, you must file these forms:

Educational Paraprofessional Leave Application

Educational paraprofessionals should use this form for initial requests for leaves of absence as well as requests for extensions. Requests for extensions must be submitted prior to the date of expiration of the current leave.

EB1054 Health Benefits Report/Inquiry

You should submit this report with your Educational Paraprofessional Leave Application to prevent the disruption of your major medical insurance.

Dental Claim Form

After you have read the dental claim form instructions (below) you are ready to fill out the dental claim form as needed.

School Nurse Timesheet

Office of School Health Time Report for Nurses.

Facility-Wide Inventory of Mercury and Mercury-Containing Devices

Especially for Lab Specialists. Use Page 1 to document the presence of mercury in a science room.

Extended Session Grievance Form, Step 1

Extended Session Teacher/Student Ration Fact Sheet