EMPLOYEE INJURIES
All Mount Vernon School District employees must complete an Employee Injury form when they sustain an injury in the workplace, regardless if they seek medical care for the injury. Information collected is used to prepare required government reporting and shared with the district's safety committee. The safety committee uses the information to determine if repairs or improvements are needed to prevent further injuries from occurring.
Direct any questions to Alexia Bautista in the Personnel Department (extension #11302).
STEPS TO TAKE WHEN YOU ARE INJURED
Complete the Employee Injury Form.
Ask witnesses to complete the Statement of Witness.
Complete the Employee Return to Work Status Form if you seek medical attention for your injury.
Present your completed forms to your building administrator for their review and signature. Completed forms are forwarded to Alexia in the Personnel Department.
ACCESSING MEDICAL CARE
You may see any medical provider for your initial visit. When you check in at the medical provider's office, it is important that you:
inform the medical provider that you are there for a work-related injury or illness.
inform the medical provider that the Mount Vernon School District is a participant in the Washington State's Industrial Insurance Program and is insured through the Washington State Fund.
Complete the L&I claim form provided by the medical office. The form will have a claim number that you will reference when seeking continued medical care for your injury or when communicating with your WA state L&I claims manager.
Collect medical documentation titled Activity Prescription Form (APF) - indicating your availability to return to work at the conclusion of your visit.
You MUST present the APF to your building or deparment office. Have your building administrator or department supervisor review the medical note. They will:
Verify if you are released to return to work
Assess any restrictions in place and determine if you can return to work and successfully carry out your full duties
ABSENCES RELATED TO A WORKPLACE INJURY
Absences related to a workplace injury are not covered by the District. Employees are to report their absences as they normally would through Frontline or appropriate payroll form. Employees may access their available paid leave to cover their absences.
EMPLOYEE INJURY FORM; STATUS FORM; WITNESS STATEMENT; ACTIVITY PRESCRIPTION FORM (APF)
Employee Injury Report Form.pdfEmployee Return to Work Status.pdfStatement of Witness-Employee Injury.pdfAPF F242-385-000 11.2018.pdf