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Campus Safety Manual

Reporting Worker's Compensation Accidents

A basic concern of the University as an employer is to prevent injuries to its employees. Successful accident prevention eliminates needless suffering, reduces the cost of the Workers' Compensation program, and results in a more productive workforce. On this campus, the Human Resources Office has been assigned the functions of the Workers' Compensation Claims Coordinator and Return-to-Work.

In the event of employee injury, the following procedures are to be followed. All forms may be obtained from the Human Resources Office.

Employee Responsibilities

  • Employees injured on the job are to notify their supervisor immediately and seek emergency medical assistance. After receiving medical treatment (and hospitalization is not required), the employee must immediately complete and submit an "Employee's First Report of Injury or Illness" form to Human Resources. Should the employee require hospitalization, the supervisor and Human Resources will complete the "Employee Accident Report" form for review and signature by the employee.
  • Employees should seek whatever medical treatment is necessary to overcome the effects of such injury or occupational disease. Employees must keep their supervisor and the Human Resources Office advised of their medical status and ability to return to work.
  • If an employee is absent from work due to any job related injury, an "Employee Election of Receiving Workers' Compensation Disability Payments Per Section 12 of Article 8309g" form must be signed by the employee and submitted to the Human Resources Office.

Supervisor Responsibility

  • The injured employee should be directed to the Human Resources Office after receiving medical assistance.
  • The Human Resources Office will complete and submit an "Employee Accident Report" form within two (2) working days after any accidental injury suffered by an employee.
  • The name or names and mailing addresses of any witnesses should be obtained from the injured employee or another appropriate individual and reported on the "Witness Report."
  • The name and mailing address of the closest relative or friend should be obtained from the injured employee.
  • Immediate telephone notification should be give to the Human Resources Office in the event of any injury or death of an employee.
  • If an employee misses more than sixty (60) days of work, an "Employer's Supplemental Report of Injury" form must be submitted to the Human Resources office by the supervisor.
  • Additional supplemental reports should be submitted at least every sixty (60) days thereafter by the individual's supervisor.
  • If an employee election form has been completed, it must be forwarded to the Human Resources Office.
  • The supervisor must notify the Human Resources Office the day the employee returns to work.

Workers' Compensation Claims Coordinator Responsibilities

  • Assist the supervisor in completing the "Supervisor Investigation of Employee's Accident/Incident" form.
  • Review the accident with the Safety Advisory Committee at the next scheduled meeting.
  • Maintain claims data regarding work-related employee injury or illness and provide this documentation to the Office of the Attorney General Workers' Compensation Commission as required.
  • Complete and submit to the Office of the Attorney General Workers' Compensation Commission:
  1. Employer's First Report of Injury:
  2. Any Supplemental Reports of Injury; and
  3. Employee Election Form
  • Submit an "Employer's Wage Statement" if requested by the Office of the Attorney General.
  • Inform the Campus Risk Management Liaison at the time of injury and provide updates and summary report of estimated loss to the campus (hours work lost, medical expenses, etc.)

Safety Manual: Table of Contents