Worker’s Compensation Injury Reporting

Overview:

This document provides an overview of what’s required to report an employee injury.
The following applicable forms are located within the Risk Management Forms KB.
- RM01 Generic Incident Report
- RM03 Supervisor Report
- RM16 Return to Work Authorization
- WC Employee Report of Occupational Injury and Illness

Immediately report all on-the-job injuries to your supervisor and/or administrative secretary.
Complete and submit the Employee Report of Occupational Injury or Illness
If seeking medical evaluation/treatment, provide the RM16 Return to Work Authorization form to the attending physician.
Submit completed forms to riskmanagement@matsuk12.us

When an employee is injured at work, they should be provided with the WC Employee Report of Occupational Injury form to complete. The Supervisor should be provided with the Supervisor Incident/Injury Form to complete.
Immediately upon completion these forms should be scanned and emailed to riskmanagement@matsuk12.us for processing.
The original forms are confidential and need to be sent to Risk Management in-district mail.
If an employee seeks medical attention, they should be provided with the Return to Work Authorization to be completed by the doctor.
Notify Risk Management if the employee has time loss from the injury.
If the injury is minor, requiring only basic first aid, the employee can complete the Generic Incident Report instead. These reports should still be scanned and sent to Risk Management, then forwarded in-district mail.
If a bloodborne pathogen exposure has occurred (as defined in the Exposure Control Plan) the Exposure Incident Report should also be completed and sent to Risk Management.

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