Please fill out the form below and submit when finished.
Vector Services is concerned with every employee’s well being. In the event you elect not to seek medical attention, we need to document that Vector Services has not influenced, in any way, your decision to not seek treatment.
For work-related injuries ONLY: Should it later be determined that I require medical care, I will consult with the Vector Services safety department before seeking treatment unless emergency treatment is required.
My signature confirms that I have voluntarily waived medical care due to the injury/illness indicated above. *
