Oregon > Workers Comp > Preferred Worker Program
Preferred Worker Program Substantial Modification Determination 3297 - Oregon
| Preferred Worker Program Substantial Modification Determination Form. This is a Oregon form and can be used in Preferred Worker Program Workers Comp . |
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Preferred Worker Program Substantial Modification Determination Worker name: Date: WCD file no: Job title and brief job description: Worker injury: Permanent limitations: Worksite modification: Decision: Is the worksite modification a substantial modification according to OAR 436-110-0380(3)? Yes No Comments: Date letter sent to the worker, if applicable: (Letter states date on which substantial modification was determined and the date by which the preferred worker identification card and wage subsidy agreement must be completed and sent to WCD, if these are to be requested for the current job.) X Re-employment consultant Workers Compensation Division Department of Consumer and Business Services 440-3297 (11/01/DCBS/WCD/WEB)
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