Job Modification Agreement - Supplier Reimbursement {BWC-2964}

BWC-2964 / RH-14 - JOB MODIFICATION AGREEMENT – SUPPLIER REIMBURSEMENT. This form is used to document and process the reimbursement for job modifications made to accommodate an injured worker's return to work (RTW) under the Bureau of Workers' Compensation (BWC) program. It involves an agreement between the RTW employer, the BWC, and the supplier who provides the modification. The form collects details about the modifications, the costs, and the supplier's information. Upon BWC’s approval, the RTW employer is reimbursed for the cost of the modification. www.FormsWorkflow.com