We are committed to providing you with the highest level of customer service during your care and recovery from a workplace illness or injury. We welcome your comments. Please fill out this confidential questionnaire and return it in the self-addressed, postage-prepaid envelope. Thank you for your feedback and service to the citizens of North Carolina.


Do you consider your injury as minor, medium or severe?

- Minor (including but not limited to laceration not requiring stitches, minor burn, sprain, muscle strain, etc.)

- Medium (including but not limited to laceration requiring stitches, broken bone, muscle or ligament tear, second degree burn, etc.)

- Severe (including but not limited to amputation, loss of eye, in-patient hospitalization, etc.)"
























Validating Fields
Submitting Form



NCDOT Workers Compensation Program

MSC 1504 Raleigh, NC 27699-1504

If you have any questions, please call: 1-866-361-1818 (24/7 anonymously)

Version 1, February 13, 2018 Approved

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