Employee Injury Forms

Steps to Take if Injured on the Job:

1.  Immediately report injury to your supervisor and/or school nurse.

2.  If further medical attention is necessary after reporting to supervisor/nurse,  please go ASAP to Concentra Wesport for medical treatment.

3. If emergency treatment is necessary for serious injury or life-threatening injury, please go ASAP to DePaul Medical Center's emergency department.

4.  If no further medical attention is necessary, there is no need to go to Concentra or DePaul.

5.  If further medical attention is necessary, your supervisor or school nurse must contact the Human Resource Center ASAP so an Authorization for Treatment form can be sent to Concentra (or DePaul in an emergency situation) prior to your arrival at Concentra or DePaul.

6.  The Human Resource Center will send an Authorization for Treatment Form to Concentra or DePaul ASAP at this point.

7.  Whether further medical treatment is required or not, all employees injured on the job must complete the Employee Injury Incident Report.

8.  Whether further medical treatment is required or not, all supervisors of an employee injured on the job must complete the Supervisor's Injury Incident Report.

Employee Injury Report Form

Supervisor Accident Investigation Report Form