Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Supervisor's Investigation Report

Steps

  1. 1. 1
  2. 2. 2
  • 1

    1. City of Gadsden Supervisor's Report Form

    2. Section A - WORKER'S COMPENSATION

    3. Did employee ask to see a doctor?

    4. Was employee released to return to work?

    5. If so, attach copy of release; if not, attach copy of disability certification.

      NOTE: NO DISABILITY IS PAYABLE UNLESS AUTHORIZED BY DOCTOR.

    6. Section B - VEHICLE ACCIDENTS

    7. City Vehicle:

    8. Other Vehicle:

    9. Section C - POTENTIAL LIABILITY CLAIM

    10. Type Claim:

    11. Section D - DAMAGE TO CITY PROPERTY