Indiana Employee Waiver of Examination by Personal Physician - SF 53913

• Category: Indiana Workers Compensation - Official - General
• State: Indiana
• Control #: IN-53913-WC
• Format: PDF

Description

Employee Waiver of Examination by Personal Physician - SF 53913 Indiana Employee Waiver of Examination by Personal Physician — SF 53913 is a form that must be completed and signed by an employee who is seeking a waiver of the requirement to have an examination by his or her personal physician. This form must be submitted to the Indiana Department of Workforce Development or the Occupational Safety and Health Administration (OSHA) in order to be considered for a waiver of the examination requirement. The form contains information about the employee, his or her medical history, and the reason for requesting the waiver. It also includes various signature lines and other relevant information. There are two types of Indiana Employee Waiver of Examination by Personal Physician — SF 53913: one for employees in the private sector, and one for state employees.

Indiana Employee Waiver of Examination by Personal Physician — SF 53913 is a form that must be completed and signed by an employee who is seeking a waiver of the requirement to have an examination by his or her personal physician. This form must be submitted to the Indiana Department of Workforce Development or the Occupational Safety and Health Administration (OSHA) in order to be considered for a waiver of the examination requirement. The form contains information about the employee, his or her medical history, and the reason for requesting the waiver. It also includes various signature lines and other relevant information. There are two types of Indiana Employee Waiver of Examination by Personal Physician — SF 53913: one for employees in the private sector, and one for state employees.