Immediately report any work-related injury or illness to your supervisor then Seek Medical Attention. Your supervisor or Appropriate Administrator must complete the forms below within 24 hours of the report of injury. The forms should be submitted via DocuSign and sent to firstname.lastname@example.org. If the forms cannot be signed via DocuSign, please scan and email them to email@example.com.
- Employer's Report of Occupational Injury or Illness (.pdf) Write a description of the accident using the employee's own account of the incident.
- Workers' Compensation Claim Form (DWC 1) and Notice of Potential Eligibility (.pdf) Provide the injured employee with this form then submit to University Personnel once complete.