(a) Notice of injury, claims and certain specified reports shall be
made on forms prescribed by OWCP. Employers shall not modify these forms
or use substitute forms. Employers are expected to maintain an adequate
supply of the basic forms needed for the proper recording and reporting
of injuries.
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Form No. Title
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(1) CA-1.................................. Federal Employee's Notice of
Traumatic Injury and Claim
for Continuation of Pay/
Compensation
(2) CA-2.................................. Notice of Occupational
Disease and Claim for
Compensation
(3) CA-2a................................. Notice of Employee's
Recurrence of Disability
and Claim for Pay/
Compensation
(4) CA-5.................................. Claim for Compensation by
Widow, Widower and/or
Children
(5) CA-5b................................. Claim for Compensation by
Parents, Brothers, Sisters,
Grandparents, or
Grandchildren
(6) CA-6.................................. Official Superior's Report
of Employee's Death
(7) CA-7.................................. Claim for Compensation Due
to Traumatic Injury or
Occupational Disease
(8) CA-7a................................. Time Analysis Form
(9) CA-7b................................. Leave Buy Back (LBB)
Worksheet/Certification and
Election
(10) CA-16................................ Authorization of Examination
and/or Treatment
(11) CA-17................................ Duty Status Report
(12) CA-20................................ Attending Physician's Report
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(b) Copies of the forms listed in this paragraph are available for
public inspection at the Office of Workers' Compensation Programs,
Employment Standards Administration, U.S. Department of Labor,
Washington, DC 20210. They may also be obtained from district offices,
employers (i.e., safety and health offices, supervisors), and the
Internet, at www.dol.gov./esa/owcp.htm.
[63 FR 65306, Nov. 25, 1998; 63 FR 71202, Dec. 23, 1998]
Information in Program Records
