Employee Injury Report Form (to be completed by Employee)
Employer Basic Report of Injury Form (to be completed by Building Administrator)
MESSA Member Change Form
Used to add/remove dependents/optional benefits or name/address changes.
MESSA Member Application
Used to re-instate recalled employees and to switch from Pak A (full coverage) to Pak B (no medical).
MESSA COBRA Application
Used to elect employee paid group health coverage.