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Worker's Compensation - Supervisor Forms and Information

Supervisor Injury/Illness Reporting Procedure

  1. Initiate immediate medical attention if necessary. In the event of a medical emergency call 911 or contact University Police at 4660.
  2. Conduct investigation and correct hazards
  3. Report the injury
    Supervisors are responsible for reporting the injury or illness to the Risk Management and Safety office by telephone as soon as possible, 262-472-1856. If after hours, or if Risk Management & Safety is not available, leave a voicemail message with:
    • Name of employee
    • Date of injury/illness
    • Nature of injury/illness
    • If medical attention was sought

    If serious injury or death occurs and Risk Management & Safety is not available, contact UW-System, Office of Safety and Loss Prevention within 24 hours: 608-263-4381

  4. Complete the following forms within 24 hours of notification of the injury/illness:

    5. Employer's First Report of Injury or Disease (see sample)

    Supervisor's Accident Analysis and Prevention Report

    Retrieve the Employee’s Work Injury and Illness Report (see sample) from the Employee if not already received.

    Hand deliver the Employee’s Work Injury and Illness Report, Employer’s First Report of Injury or Disease and the Supervisor’s Accident Analysis and Prevention Report to Risk Management & Safety Hyer Hall Room 333, for processing as soon as possible, but within 24 hours of the injury/illness notification.

  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 the information to Risk Management and Safety as soon as possible. The University of Wisconsin System has an Early Return to Work Policy. Contact Risk Management and Safety to discuss whether temporary modified duty is available within given work restrictions. When appropriate, find or develop modified duty assignment to the employee within 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 the employee’s lost time from work is more than 3 days after the date of injury, contact the Worker’s Compensation Coordinator. Medical documentation is required to substantiate disability payments under Worker’s Compensation.
  7. Maintain contact with the injured worker and Risk Management & Safety regarding health condition, treatment and medical status 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