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WCL Example

W.CL Forms and Document Guidelines

W.CL FORMS PIC
W.CL FORMS FROM DEPARTMENT OF LABOUR

WCL Document Guidelines

W.CL.1 Employer’s Report of an Occupational Disease
Purpose of form
This report must be completed in respect of an alleged occupational disease which an employee when he reports it alleges that the disease arisen out of and in the course of his employment irrespective of the fact that he may have contracted the disease in the employment of a previous employer.
Who completes the form
Employer.
When to complete the form
As soon as an employee provides the employer with a medical declaration of a disease that he suspected to contract from the workplace.
W.CL.2 Employer’s report of an accident
Purpose of form
This report must be completed in respect of an alleged occupational injury which an employee when he reports it alleges that the injury arisen out of and in the course of his employment.
Who completes the form
Employer.
When to complete the form
As soon as an employee reports the accident to his employer and that such an injury requires medical treatment from a registered medical practitioner.
W.CL.3 Notice of accident and claim for compensation
Purpose of form
This report must be completed to inform the compensation commissioner of the accident and requested claim for compensation.
Who completes the form
Employee.
When to complete the form
Whenever the employee is eligible to claim for the injury after receiving a WCL4 form.
W.CL.4 First Medical Report in Respect of an Accident
Purpose of form
This report must be completed after the first treatment given by the medical practitioner in order to diagnose and specify the severity and type of injury sustained by the employee.
Who completes the form
Registered Occupational Medical Practitioner.
When to complete the form
After first medical treatment given by medical practitioner.
W.CL.5 Final/Progress Medical report in respect of an accident
Purpose of form
This report must be completed whenever the employee visits the medical practitioner for treatment but no less than every month. The report is to specify the progress of treatment related to the injury sustained at the workplace and eventually finalise the report to indicate that no further treatment is needed.
Who completes the form
Registered Occupational Medical Practitioner.
When to complete the form
This report must be completed on a monthly basis (or as specified by medical practitioner visits) until a final medical report is given to finalised the treatment. This form will also be completed with a final report from 2 years after the incident has occurred.
W.CL.6 Resumption Report
Purpose of form
This report must be completed to specify when the injured employee has returned to work to perform light duty and/or normal duty work.
Who completes the form
Employer.
When to complete the form
This report must be completed on the day the employee returns to work and resumes either light duty or normal duty work.
W.CL.110 Exposure History
Purpose of form
This report must be completed to specify the periods of exposure within a hazardous area that may have contributed to the employee’s disease.
Who completes the form
Employee.
When to complete the form
This form must be completed after completing the WCL1 and if requested by medical practitioner or department of labour.
W.CL.132 Affidavit by employee
Purpose of form
This report is completed and serves as an affidavit to the compensation commissioner that the employee acknowledges that he was injured on duty.
Who completes the form
Employee.
When to complete the form
To be completed with WCL3.
W.CL.14 Notice of an occupational disease and claim for compensation
Purpose of form
This report must be completed to inform the compensation commissioner of the disease and requested claim for compensation.
Who completes the form
Employee
When to complete the form
Whenever the employee is eligible to claim for the injury after receiving a WCL22 form.
W.CL.15 Strain or Sprain Questionnaire
Purpose of form
To report a strain and sprain to claim from the Compensation Fund.
Who completes the form
Employee.
When to complete the form
Whenever the employee is eligible to claim for the injury after receiving a WCL4 form.
W.CL.20 Inquiry regarding unpaid medical or chemist account
Purpose of form
This report must be completed to inquire unpaid medical or chemist accounts.
Who completes the form
Registered Occupational Medical Practitioner.
When to complete the form
This form is completed whenever medical or chemist accounts are not paid.
W.CL.21 Goggle Questionnaire
Purpose of form
This questionnaire is used for assessing whether or not a worker was wearing protective eyewear during an accident.
Who completes the form
Employer.
When to complete the form
This report must be completed as soon as possible during the investigation stages of the accident.
W.CL.215 Special report of hernia case
Purpose of form
A form to be completed when reporting a hernia injury of a worker.
Who completes the form
Employer.
When to complete the form
This form must be completed and submitted with the WCL2 or can also be submitted directly after receiving the WCl4.
W.CL.22 First medical report in respect of an occupational disease
Purpose of form
This report must be completed after the first treatment given by the medical practitioner in order to diagnose and specify the severity and type of disease contracted by the employee.
Who completes the form
Registered Occupational Medical Practitioner.
When to complete the form
After first medical treatment given by medical practitioner.
W.CL.221 Supplementary Report on Injury to foot
Purpose of form
This form must be completed to provide additional information regarding foot injuries.
Who completes the form
Registered Occupational Medical Practitioner.
When to complete the form
This form will be completed by the medical practitioner during the first medical treatment.
W.CL.236 Sworn or confirmed statement by employee
Purpose of form
A form to be completed for sworn statements by a worker when reporting an accident.
Who completes the form
Employee
When to complete the form
To be completed by employee on special request of the Department of labour when reporting an accident.
W.CL.258 Payment of lumpsum in lieu of pension
Purpose of form
A form acknowledging payment of a lumpsum from the compensation fund.
Who completes the form
Employee
When to complete the form
After receiving payment of a lumpsum from the compensation fund.
W.CL.26 Final/Progress Medical report in respect of an occupational disease
Purpose of form
This report must be completed whenever the employee visits the medical practitioner for treatment but no less than every month. The report is to specify the progress of treatment related to the disease contracted at the workplace and eventually finalise the report to indicate that no further treatment can be rendered.
Who completes the form
Registered Occupational Medical Practitioner.
When to complete the form
This report must be completed on a monthly basis (or as specified by medical practitioner visits) until a final medical report is given to finalised the treatment. This form will also be completed with a final report from 2 years after the disease was confirmed and treated.
W.CL.287 Application for supplementary Grant
Purpose of form
An application form for additional compensation for a permanently disabled worker.
Who completes the form
Employee
When to complete the form
This application can be completed after particulars of applicant who is permanently disabled and whose compensation has been exhausted.
W.CL.303 First Medical report in respect of post traumatic stress disorder
Purpose of form
This report must be completed after the first treatment given by the medical practitioner who specialises in post-traumatic stress disorder in order to diagnose and specify the severity and type of psychiatric disorder the employee has.
Who completes the form
Registered Occupational Medical Practitioner specialising in post-traumatic stress disorder
When to complete the form
After first medical treatment given by medical practitioner specialising in post-traumatic stress disorder.
W.CL.304 Final/Progress medical report in respect of post traumatic stress disorder
Purpose of form
This report must be completed whenever the employee visits the medical practitioner specialising in post-traumatic stress disorder for treatment but no less than every month. The report is to specify the progress of treatment related to the disorder due to the workplace accident and eventually finalise the report to indicate that no further treatment is required.
Who completes the form
After first medical treatment given by medical practitioner specialising in post-traumatic stress disorder.
When to complete the form
This report must be completed on a monthly basis (or as specified by medical practitioner visits) until a final medical report is given to finalised the treatment.
W.CL.305 Employee affidavit for an occupational disease
Purpose of form
This report is completed and serves as an affidavit to the compensation commissioner that the employee acknowledges that he contracted a disease from a workplace environment.
Who completes the form
Employee.
When to complete the form
To be completed with WCL14.
W.CL.31 Supplementary report on injury to hand
Purpose of form
This form must be completed to provide additional information regarding hand injuries.
Who completes the form
Registered Occupational Medical Practitioner.
When to complete the form
This form will be completed by the medical practitioner during the first medical treatment.
W.CL.32 Declaration by guardian or widow or widower
Purpose of form
A declaration form for compensation funds by the widow/widower or guardian of deceased worker.
Who completes the form
Guardian or widow or widower.
When to complete the form
To be completed by the guardian/widow/widower directly after the death of the employee.
W.CL.44 Medical Report on health of worker
Purpose of form
A confidential medical report on the health of a worker examined by a medical practitioner.
Who completes the form
Registered Occupational Medical Practitioner.
When to complete the form
This document will be completed by the medical practitioner as and when required to determine the current health condition of the employee
W.CL.45 Tenosynovitis Questionnaire
Purpose of form
A questionnaire to be completed by a worker if he has been diagnosed with Tenosynovitis
Who completes the form
Employee
When to complete the form
After diagnosed by a medical practitioner with Tenosynovitis.
W.CL.46 Burial expense account
Purpose of form
A form for applying for payment of a burial account.
Who completes the form
Guardian or widow or widower.
When to complete the form
After obtaining a quote or invoice regarding burial costs.
W.CL.52 Final report on eye injuries
Purpose of form
This form must be completed to provide a final diagnose of an injury relating to an eye injury.
Who completes the form
Registered Occupational Medical Practitioner specialising in vision
When to complete the form
This form will be completed by the medical practitioner when required, commonly given with the final medical report.
W.CL.53 Dermatological report
Purpose of form
This report is to provide information regarding the effects on skin due to an accident. This form may be used by a medical practitioner instead of a first medical report (WCL4).
Who completes the form
Registered Occupational Medical Practitioner specialising in skin.
When to complete the form
After first medical treatment given by medical practitioner.
W.CL.69 Claim for subsistence and transport expenses
Purpose of form
A claim form for subsistence and transport expenses.
Who completes the form
Employee
When to complete the form
After calculating traveling costs for medical treatment purposes.
W.G.29 Objection against a decision of the commissioner
Purpose of form
This form must be completed to object against a decision of the commissioner
Who completes the form
Employer /Employee / Trade Union
When to complete the form
“lodged within 180 days “means that the objection must reach the Commissioner within 180 days from the date of his/her decision.
W.G.30 Application for additional compensation
Purpose of form
An application form for additional financial assistance from the compensation fund.
Who completes the form
Employee.
When to complete the form
Whenever the employee believes that he is entitled for additional compensation.
W.G.33 Request for payment of pension via electronic transfer
Purpose of form
A form requesting pension funds to be paid via electronic transfers.
Who completes the form
Employee
When to complete the form
Whenever the employee is entitled to compensation and requires these payments to be made via electronic transfer.

DOWNLAOD Form – COID – First Medical Report in respect of a work related upper limb disorder

Got all of the guidance from official South African department of labour page

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