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C-4: Physician’s Report

Your doctor must fill out this form at regular intervals — usually every 4-6 weeks — during your convalescence. It is used to determine your level of benefits — so it is very important that your doctor fills it out carefully.

C-257: Expense Reimbursement Form

Use this form to claim out-of-pocket expenses related to your injury or illness.

DB-450: Disability Claim

Complete this form to claim disability benefits only if your Workers’ Compensation claim has been rejected.

MD-1: Request for Medical Authorization

Here is the form for an attending doctor to obtain medical authorization:

WCD-23: Employee’s Notice of Injury

Complete this form and file it with your school payroll secretary within 10 days.

CAR Transfer Form

All pedagogues and paraprofessionals may use this form to donate sick time to a colleague. The recipient receives one day for every two days donated. Sick leave transfer rules are on page 2 of the form.

OP 160: Leave of Absence Without Pay

All pedagogical personnel may apply for a medical leave of absence without pay only when they have exhausted all of their Cumulative Absence Reserve (CAR) days. This application must be completed, signed and submitted to HR Connect for approval...

OP 255: Resumption of Service Report

Upon an employee’s return from a leave of absence without pay, the payroll secretary must submit an OP 255 form to the Bureau of Salary Differentials and Status.

Chancellor's Regulation C-650: Sabbatical Leaves of Absence

This regulation sets forth the rules governing sabbatical leave of absence applicable to all pedagogical personnel.