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

Safety/Risk Control

Accident Investigation

Accident Investigation Form

Claims Management

Claims Procedures - WC

Safety Meeting Topics - Short (Table of Contents)

Video Library List

Video Request Form - (pdf)

Video Request Form - (doc)

MORE RISK CONTROL HANDOUT & FORMS

Safety 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