IOD Forms

Anaesthesia Form

Form for anaesthesia services under COIDA.

Annexure F

Additional documentation for COID claims.

Assault Report Form

Form for reporting assaults in terms of COIDA.

COID - W.Cl.26 - Progress Medical Report (Occupational Disease)

Progress medical report in respect of an occupational disease.

COID - W.Cl.14 - Notice of Occupational Disease and Claim

Notice of occupational disease and claim for compensation.

COID - W.Cl.6 - Resumption Report

Report for resumption of work.

COID - W.Cl.4 - First Medical Report

First medical report in respect of an accident.

Pre-Authorisation Request Form

Form to request pre-authorisation for treatment.

COID - WCL236 - Sworn/Confirmed Statement by Employee

Sworn or confirmed statement by employee.

COID - W.Cl.2 - Employer's Report of an Accident

Employer's report of an accident.

COID - W.Cl.1(E) - Employer's Report of Occupational Disease

Employer's report of an occupational disease.

COID - W.Cl.22 - First Medical Report (Occupational Disease)

First medical report in respect of an occupational disease.

Pre-Authorisation Request Form

Form to request pre-authorisation for treatment.

COIDA Service Guide

Comprehensive guide to COIDA services and procedures.

COVID-19 Questionnaire

Questionnaire for COVID-19 related claims under COIDA.

COVID-19 Exposure and Medical Questionnaire

Questionnaire for COVID-19 exposure and medical history.

COVID-19 Compensation Notice

Notice on compensation for occupationally acquired COVID-19.

COID - W.Cl.110 - Exposure History

Form to document exposure history.

COID - W.Cl.4 - First Medical Report

First medical report for COID claims.

Physiotherapy Part 1 - Initial Evaluation and Plan

Initial evaluation and treatment plan for physiotherapy.

Physiotherapy Report - Part 1

Physiotherapy treatment report part 1.

Physiotherapy - Motivation for Additional Sessions

Motivation for multiple physiotherapy sessions per day.

Physiotherapy Report - Part 2

Physiotherapy treatment report part 2.

Physiotherapy Report - Part 3

Physiotherapy treatment report part 3.

Physiotherapy Part 3 Report

Part 3 of the physiotherapy treatment report.

Physiotherapy Part 2 Report

Part 2 of the physiotherapy treatment report.

COID - W.Cl.5 - Final or Progress Medical Report

Final or progress medical report for COID claims.

COID - W.Cl.5 - Final or Progress Medical Report

Final or progress medical report for COID claims.

Transport Questionnaire

Questionnaire for transport-related claims.

COID - W.Cl.20 - Enquiry Re Unpaid Account

Enquiry regarding unpaid medical or chemist account.

RMA - Re-Opening of Finalised Claim / Pre-Authorisation Request

RMA form for re-opening finalised claims or pre-authorisation.

RMA - Accident Claim Form

RMA accident claim form.

RMA - Authorisation Request Form

RMA authorisation request form.

RMA - First Medical Report

RMA first medical report.

RMA - Progress Medical Report

RMA progress medical report.

RMA - Final Medical Report

RMA final medical report.

FEM Authorization Form

Authorization form for FEM claims.

FEM - Annexure C - First Rehabilitation Authorisation Report

FEM first rehabilitation authorisation report.

COID - W.Cl.4 - First Medical Report

First medical report for COID claims.

FEM - Annexure D - Monthly/Interim Rehabilitation Report

FEM monthly or interim rehabilitation report.

FEM - Annexure E - Final Rehabilitation Report

FEM final rehabilitation report.

COID - W.Cl.5 - Final or Progress Medical Report

Final or progress medical report for COID claims.