Vaw workers compensation 2026

1. Click ‘Get Form’ to open the vaw workers compensation document in the editor.
2. Begin by filling in the 'To' section with the name and title of the officer responsible for receiving this notice.
3. In Section 1, provide the full name of the volunteer ambulance worker, including first name, middle initial, and last name. Also, include their home address.
4. Complete Section 2 by entering the name of the ambulance company associated with the volunteer worker.
5. If applicable, fill out Section 3 with details about the political subdivision or ambulance district involved.
6. In Section 5, specify the address where the injury occurred. Ensure accuracy for proper processing.
7. For Section 6, record both the date and time of injury (or death) and provide a detailed account of what happened in Section 7.
8. Finally, sign and date at the bottom of the form. If someone is signing on behalf of another, include their relationship to ensure clarity.

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