Online Library
Please click on the form you wish to access.
Seubert Safe Workplace Program
- Complete Seubert Safe Workplace Program
- Employee's Acknowledgement of Physicians Panel
- PA-Approved Safety Committee Guidelines(link to webpage of the PA Dept. of Labor & Industry)
- Injured Employee Report
- Witness Incident Report
- Employer's Job Evaluation
- Physician's Evaluation
- Modified Duty Form
Worker’s Compensation
Automobile Accidents
Bond Forms
- Bid Bond Request Form (To be used if a specific bid bond is required. If performance, payment and/or maintenance bonds are required, please provide a copy of the contract.)
- Bid Results Form (To be used if performance payment and/or maintenance bonds are required.)
- Contractor’s Questionnaire
- Personal Financial Statement
- Work in Progress Report
Employee Benefits
- Medicare Creditable Coverage Model Notice
- Medicare Creditable Coverage Reporting to CMS
- Sample COBRA Initial Rights Notice
A PDF reader is required to view a file presented in the PDF format.
Download a Free PDF Reader.
