Ups hrsc 2026

1. Click ‘Get Form’ to open the ups hrsc in the editor.
2. Begin with Section 1, where you will enter your Participant’s Information. Fill in your Identification Number, Full Name, Date of Birth, Complete Address, and Employer details. If applicable, indicate the Date of Accident and answer the accident-related questions.
3. Proceed to Section 2 for the Physician’s Statement. Your treating physician must complete this section by providing their name, phone number, diagnosis, treatment plan, and any hospitalization details.
4. Finally, Section 3 requires your Employer’s Statement. Ensure that your employer fills in the last day worked and any relevant layoff information. They must also sign and date this section.
5. Once all sections are completed, review for accuracy before submitting via mail or fax as indicated on the form.

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