LA OWCA Second Injury Board Knowledge Questionnaire WARNING 2026

1. Click ‘Get Form’ to open the LA OWCA Second Injury Board Knowledge Questionnaire in the editor.
2. Begin by entering your employer's name in the designated field at the top of the form.
3. Fill in your personal details, including your name, date of birth, gender, and last four digits of your Social Security number.
4. Provide your home address and telephone number. Ensure all information is accurate to avoid any issues.
5. In the medical conditions section, check all applicable boxes for conditions you currently have or have had previously. Use the Explanation Page for additional details.
6. Complete the surgical treatment section if applicable, indicating any surgeries you've undergone along with approximate years.
7. Answer the follow-up questions regarding activity restrictions and current treatments. Be thorough and honest as this impacts your workers' compensation benefits.
8. Finally, sign and date the form at both employee and employer witness sections to validate it before submission.

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