Accident Reports-Worker's Compensation
Source: Office of the Vice Chancellor, Administrative Affairs
The purpose of this information is to alert all employees, faculty, classified, and students as to the importance of reporting workplace accidents promptly to your immediate supervisor, and completion of accident reports by the employee and supervisor. The following procedures will be followed:
- In the event of a workplace accident which causes injury or requires medical attention, the employee must report to the supervisor and injured employee within 24 hours, pick up an Employer's First Report of Injury or Disease (WC-12), complete, sign, and send to the Risk Manager. This must be done by the supervisor and injured employee within 24 hours of an accident. All the other necessary paper work will be done in Risk Management after the WC-12 forms are received. In the event of a catastrophic or very serious accident or death, the supervisor must call the Risk Manager and report the accident so that State Risk Management, Department of Administration can be notified. If the incident occurs after work hours or on weekends, the supervisor should notify University Police. They will have instructions on how to contact the Risk Manager or alternate persons in State Administration.
- Reporting of accidents weeks or months after or when Risk Management receives a doctor or hospital emergency room bill and finds no accident report will be reviewed by the Department of Commerce and proper action for noncompliance will follow.
- In the event of lost time, it is important that Risk Management is made aware of time lost and what option the employee wishes to use to stay on the payroll. (Example: Use of sick leave and charge back credits, etc.). The Risk Manager will review options with each claimant.
- The WC-12 form is black and white, and two-sided form. All forms are available in Risk Management. Please keep in mind, however, that you have 24 hours to report the accident and to get the form completed and returned; therefore, inter-office mail will not accomplish this.
The Department of Administration has put a strong emphasis on the process of prompt reporting and issuance of checks for lost time within ten days and will assess a 10% penalty which will be charged back to the department responsible for non-compliance. If the employer is guilty of a safety violation, a 15% penalty will be charged to the department in violation.
Safety is important. We need to make sure that injured employees are properly treated, receive pertinent information, and the necessary paper work and follow up are done. Cooperation is the key to a safe work environment and an effective Worker's Compensation Program.
As amended 10 November 2000
Last Reviewed: October 2015