Worker's Compensation

Employee's Work Injury And Illness Report	Sample (Fill in Highlighted Areas Only)
Employer's First Report of Injury or Disease*	Sample (Fill in Highlighted Areas Only)
Supervisor's Report Form*

All of the three forms above are required to be completed for every workers compensation claim. Employee's Work Injury and Illness Report is to be completed by injured employee. Employer's First Report of Injury or Disease and Supervisor's Report Form are to be completed by injured employee's supervisor. Do not transmit these completed forms via e-mail as they contain confidential information.

• Early Return to Work Agreement Form*
• Early Return to Work Policy
• Office of Safety & Loss Prevention (UW System)
• Wisconsin Worker's Compensation Guide
• Worker's Compensation Claims Fact Sheet

(*) Indicates that Documents are in MS-Word Format.

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