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CASE INFORMATION SHEET (CIS)



Vs





WC #-###-###-##
Case Information Sheet
hearing location

2. CASE STATUS Check and complete, as appropriate:

Is a Pre-hearing or settlement conference scheduled?



3. Discovery 




5. ISSUES REMAINING FOR DETERMINATION Check all issues that remain:





6. List the lay witnesses you intend to call in your case-in-chief: 












7. List the expert witnesses you intend to call in your case-in-chief: 













(in minutes)
Please type your name in the box below.  By typing your name, you certify this information is accurate and certify that this will act as your binding electronic signature. 











Certificate of Mailing

I hereby certify that I mailed or delivered the original Case Information Sheet (CIS) to all parties at the addresses shown below (A claimant must provide a copy to the employer and the insurer, or their attorney):

Opposing Party 1 or their Representative









#####

###-###-####


Opposing Party 2 or their Representative









#####

###-###-####


Please type your name in the box below.  By typing your name, you certify this information is accurate and certify that this will act as your binding electronic signature. 


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