Policy: OKDHS 2-15-1.1
For further information regarding Reporting a Workplace Accident, refer to the SOP.
An employee who sustains a work-related illness or injury while acting within the scope of employment is required to report the work-related illness or injury to his or her Supervisory Immediately after the accident occurs or the work-related illness is known, unless incapacitated.
- Supervisor MUST complete the WC Incident Investigation Report (form-Must include the employee’s name, PeopleSoft ID number, date and time of injury or illness, and the date and time the employee was notified.
- If “NEAR MISS” is checked (no medical attention sought), the only additional forms required are:
- Supervisor MUST review and complete Leave Option Election with employee (complete even if employee is not missing work)
- Supervisor MUST review and complete the WC Employee Information Packet with the employee. Provide copies of all documents below to employee with WC claim number printed in upper right hand corner of each document prior to directing to a designated medical facility.
- Gallagher Bassett Coversheet
- Authorization for Release of Information
- Authorization for Initial Treatment
- Network Providers
- WC Prescription Drug Program
- Prescription Program For Work-Related Injuries
- Return to Work form (mandatory and completed by the employees medical provider and returned prior to the employee reporting back to duty)
- All completed forms MUST be given to CWS AAII for Child Welfare Staff ONLY! All other divisions will go to the AFS AAII – (CWS AAII will provide copies for AFS AAII)
- AFS AAII’s MUST scan and submit all workers’ compensation forms and information to email@example.com and STO.HRMD.RISKMGMT@okdhs.org
- Supervisor completes the WC Physical Demands Questionnaire with the employee and submits a copy to CWS AAII (if CWS staff) or for all other divisions, to the AFS AAII who will then send to STO.HRMD.RISKMGMT@okdhs.org as soon as possible but no later than ten calendar days after the date of injury.
Special Instructions: When submitting paperwork, please include the following information for each employee in the body of the email:
- Department of Human Services/830
- County name
- Contact name, title, email address and telephone number
- State if it’s an “Info Only” report