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How to use or fill out Form 16874 with our platform
- Click ‘Get Form’ to open Form 16874 in the editor.
- Begin by filling out Section 1, which requires your employer's information. Enter the name and contact details of Union Pacific Railroad.
- Complete the employee section by providing your name, job title, phone number, service unit or department, and employee ID.
- Indicate the reason for your leave by checking the appropriate box and providing any necessary details such as estimated due dates or care requirements.
- In the health care provider section, ensure that all applicable questions are answered thoroughly. This includes medical facts supporting your condition and any required follow-up visits.
- Review all entries for accuracy before signing and dating the form. Ensure that both you and your family member (if applicable) have signed where indicated.
- Finally, return the completed form to Union Pacific Railroad’s Health and Medical Department via mail or fax as specified at the bottom of the form.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2010 | 4.8 Satisfied (45 Votes) |
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