Regarding Workers’ Compensation Pre-Existing Medical Conditions Questionnaire
- Note that the witness does not have to be your supervisor.
- Should you fill out the form, remember your supervisor or other witness is ONLY to WITNESS your signature and should NOT READ any of the information your provided.
- It is inappropriate for you to forward your unsealed completed form to any designated collection person for your supervisor to sign in bulk. This will compromise your confidentiality and privacy.
- We recommend that, should you fill out the form, you walk it to your supervisor or other witness and watch them sign it, then, seal it yourself as per the instructions.
- Remember everyone now has employee ID #’s which can be used on the front of the envelope where it asks for SS #.
- Concerning the destination of these forms, as per the director of Human Resources,
“When we receive the E-2 questionnaire form it remains sealed, and is put into the employee's confidential ADA medical file. Upon separation of the employee, the ADA and the employee's personnel files are both moved to our inactive file cabinet (locked). It is not forwarded to any state office and will eventually (after several years) be purged from our inactive file cabinet, boxed and stored with all other terminated files on campus.”
Should you have any concerns about this process, we encourage you to speak to your supervisor directly. You may also contact your USAC representative if you feel we might be of assistance in any way.