CA-2: Occupational Disease Claim Form

The CA-2 Notice of Occupational Disease form should be used if you have sustained an occupational disease injury on the job.  An Occupational Disease is a condition produced in the work environment over a period longer than one work day or shift. It may result from systemic infection, repeated stress or strain, exposure to toxins, poisons or fumes, or other continuing conditions of the work environment.

All workplace-related injuries must be reported as soon as possible to the Occupational Medical Service (OMS). OMS will provide you with further instructions on how to complete the form needed in the ECOMP system.

For further guidance on using ECOMP:

Procedures after completing the CA-2

Once the forms are completed in ECOMP, they should be printed, signed and given to your supervisor. The supervisor completes his/her section in ECOMP, prints the form and signs it. An original copy of the completed, signed CA-2 form must be sent to the NIH Workers’ Compensation Program.

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