Operating Engineers Form for State Unit 12 Members
We urge all State Unit 12 workers to join their Operating Engineers local union. Membership carries many benefits, including the most important benefit, the strength of numbers. You can print the linked form (listed on the left) or save the PDF to your own computer and print it later. Or you can visit any local office for forms and guidance. Your home local may have different or additional forms for you to complete.
A link to the State of California Contract Grievance form (STD 630) is shown to the left. In general, you can print or save the grievance form from the site linked at left, and send or fax the completed form to your nearest local office or to the central office (see the address at the bottom of this page). Check with your home local to be sure of following the grievance process that applies to you.
Workers' Compensation Physician Designation Form
In accordance with the workers' compensation reform law enacted April 19, 2004, you are allowed to pre-designate your primary care physician as your personal physician for your workers' compensation medical treatment. This is a simple, 1-page form. Click here to view this form. When the form is displayed, you can either print the form or save it to your local computer.
If you pre-designate your personal physician and provide notice of that pre-designation to your employer prior to any injury, you will be allowed to be treated by your personal physician for any work-related injuries.
Pre-designating your physician does not mean that you will not receive necessary emergency medical care, nor does it mean that your personal physician will not be able to refer you to other specialists within the program in which you are enrolled. If you do not pre-designate your personal physician, your employer or your employer's workers' compensation insurer will have sole control over your medical care for any work-related injury.
You should give a properly completed pre-designation of physician form to your employer at the same time you present your dispatch slip. A new pre-designation of physician form should be tendered to each new employer to whom you are dispatched.
You should keep a copy of every fully completed pre-designation of physician form submitted to employers with your personal records. You should contact your personal physician in order to be certain that your personal physician agrees to pre-designation.
The Worker's Compensation Doctor Designation form is in MS Word format and may be downloaded by clicking here.