Job-Related Injury or Illness Supervisor Responsiblities

  1. Ensure that employee gets appropriate medical attention.
    1. If requires immediate emergency assistance, call 9-1-1 (rings at public safety office).
    2. If treated in department (band-aid, etc.):
      1. Prepare Supervisor's Injury Prevention Report (STD. 620) and send to Human Resources.
      2. No employee claim is required.
    3. If needs treatment outside the department:
      1. Arrange for or administer first aid.
      2. Take employee to Student Health Center, if open.
      3. Otherwise, take employee to Mad River Community Hospital Express Care, our approved medical facility.
  2. Complete all report requirements if employee treated outside department.
    1. Employee's Claim for Workers' Compensation Benefits (DWC Form 1).
      1. Give blank DWC Form 1 to employee within in 24 hours of notification of injury or illness.
      2. When form is returned by employee:
        • Complete employer's section.
        • Give employee "Employee's Temporary Receipt."
        • Send the first three copies to Human Resources within one working day of receipt of form from employee.
    2. Make preliminary investigation of accident.
      1. Complete Supervisor's Injury Prevention Report (Form 620).
        1. Fill in all areas of form as completely as possible (see additional instructions).
        2. Attach clarifying statements as needed to express any work-related concerns and impressions. TPA will investigate further if necessary.
        3. Deliver first two copies to Human Resources within 24 hours of notification of major injury or illness.
        4. Do not wait for employee to return employee claim form. Delay in submitting form could cause delay in employee receiving benefits and could result in HSU being assessed financial penalties by state Workers' Compensation Division.
      2. Notify department's attendance clerk or appropriate department representative.
    3. Stay actively Involved in the status if the employee.
      1. Notify Human Resources if employee misses work beyond date of injury.
      2. Keep in personal contact with off work employee.
        1. Discuss progress and possible return-to-work date.
        2. Call periodically to see if received disability payment, has any questions, etc.
        3. Reassure that job will be kept open and you want them back.
        4. Show that you care - send cards, flowers, visit hospital
        5. Treat injured employee same way you would want to be treated!
      3. Keep Human Resources informed of employee's status.
      4. Notify Human Resources as soon as employee returns to work.
        • Employee must have written release to work from treating physician before being allowed to return to work.
    4. Get employee back to work as soon as medically possible.
      1. If necessary, modify job duties to include lighter and/or part time work based on:
        1. Employee's education, training and work experience.
        2. How soon employee is expected to resume full duty status.
        3. Any work restriction imposed by treating physician.
      2. Under no circumstance should injured employee be placed in job where medical condition will be aggravated or cause harm to fellow employees or state property.