Employee Injury Forms


    I. Reporting an Injury

    A) An employee who sustains a work related injury must complete a “Report of Injury” form. Employees must provide as many details as possible, including: name, work location, nature of injury, place and time of injury occurred. Forms can be found on the District “I” drive: HumanResources/HRForms/New Interactive Forms.
    B) The form must complete and signed by the supervisor and sent to the Office of Human Resources within 24 hours of the incident. (All injuries must be reported, regardless of requiring medical attention).
    C) Employees who sustain work related injuries after normal business hours that require immediate medical attention are should visit the Concentra Medical Center and report the injury the next morning.

    II. Witness Statement

    A) Injury witnesses must complete & sign a Witness Statement and submit it to Human Resources within 24 hours of date of injury.

    III. Waving Treatment

    A) An employee who declines medical attention must complete a declination of treatment form and submit it to the office of Human Resources.

    IV. Returning to Work

    A) An employee who is deemed medically unable to return to work as determined by the Concentra must immediately notify his or her Supervisor and the Office of Human Resources immediately.
    B) The Office of Human Resources will provide notification to the employee’s building supervisor regarding their return.

    Any Questions, please contact the Office of Human Resources.