When an employee experiences a workplace injury or illness, workers’ compensation insurance covers related medical care, part of lost wages and permanent disability. Employees should report all work-related injuries to their supervisors immediately no matter the severity. Human Resource Management’s Risk and Safety Management
The employee’s supervisor completes a thorough investigation of the incident using the workers’ compensation checklist below and submits it to OMES-State Risk Management and HRM-Risk and Safety Management.
- Gallagher Bassett Cover Sheet
- Worker’s Compensation Checklist
- Workers’ Compensation Incident Investigation Report
- Gallagher Bassett Authorization for Release of Information
- Authorization for Initial Treatment
- First Script Prescription Program for Work-Related Injuries
- Return to Work Form
- Leave Option Election
For questions regarding Worker’s Compensation forms – contact Metish Farrow.
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