MMSC Forms

MMSC Forms

© Mississippi Municipal Service Company All Rights Reserved

Workers’ Compensation

First Report of Injury - MMSC

Front Page - Form (pdf)

Front Page - Form (doc)

Back Page - Instructions (pdf)

Back Page - Instructions (doc)

Template - MWCC Form/Instructions (Acrobat 6.0 - pdf)

HIPAA Medical Authorization Form

Physician Of Choice Form

Work Status Report

Mileage Reimbursement Form

Employee Wage Record

Liability Plan

Automobile Loss Notice

General Liability Loss Notice

Risk Control - Safety & Loss Prevention

Safety Handouts

Risk Control Bulletins

Underwriting

Workers’ Compensation

Application - WC Group

Coverage Policy

Estimated Payroll Summary Form - Municipal

Estimated Payroll Summary Form - Schools/Colleges

Payroll Self Audit - Municipal

Payroll Independent Audit - Municipal

Payroll Independent Audit - Schools/Colleges

Liability

Application - Liability Plan

Liability Exposure Survey

Workers’ Compensation

First Report of Injury

Physician Choice

Municipal Liability

General Liability

Automobile Liability

(Safety/Loss Prevention)