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Worker's Compensation - Employee Forms and Information

Employee Injury/Illness Reporting Procedure

  1. In the event of a medical emergency call 911 or contact University Police at 4660.
  2. Report the injury or illness to your supervisor immediately. Failure to report the injury/illness on the day of injury may compromise your claim.
  3. Complete the Employee’s Work Injury and Illness Report (see sample) within 24 hours of injury/illness. Return it to your supervisor.
  4. Seek medical attention if necessary. If medical treatment is required, review the Medical Fact Sheet.

    5. When you seek medical treatment, advise the provider you have a worker's compensation claim and to submit medical bills to your campus worker's compensation coordinator. Should you receive medical bills, including prescription receipts, submit them to the worker's compensation coordinator on your campus.

    Amy Stritzel, Worker’s Compensation Coordinator
    UW-Whitewater Risk Management & Safety
    800 W. Main Street, Hyer Hall Room 333
    Whitewater, WI 53190
    Phone: 262-472-1856
    Fax: 262-472-5668

  5. When a work related injury results in work restrictions, or an absence from work, a work slip showing the reason and effective dates is required. Provide work slip to supervisor or Risk Management as soon as possible. The University of Wisconsin System has an Early Return to Work Policy. Your supervisor will contact Risk Management & Safety to discuss whether temporary modified duty is available within given work restrictions. The employee may be placed in another department temporarily if the employing department cannot accommodate restrictions. The employing department continues to pay wages.
  6. If lost time from work is more than 3 days after the date of injury, review the Lost Time Fact Sheet and contact your Worker's Compensation Coordinator. Medical documentation is required to substantiate disability payments under Worker's Compensation.
  7. Provide regular updates on health condition, treatment and medical status to your supervisor at least weekly until end of healing has been reached.

If you have any questions about reporting or procedures contact Risk Management & Safety at 262-472-1856