Department of Risk Management & Safety
On The Job Injury Reporting
If a UVM employee has a work-related injury or illness (a condition that develops over time, such as carpal tunnel syndrome or tendinitis), he/she must fill out an Employer's First Report of Injury form. Both the Worker's responsibilities and the Supervisor's responsibilities are listed below.
1. NOTIFY YOUR SUPERVISOR as soon as possible and assist him or her in completing an Employer's First Report of Injury. Send the completed form to Risk Management. Risk Management must send the Report to the Department of Labor and Industry within 72 hours of the date of injury, subject to penalty for non-compliance.
2. TELL YOUR DOCTOR THAT YOU WERE INJURED ON THE JOB. Medical bills should be sent to Risk Management for payment under worker's compensation (not your health insurance plan). Receipts for out of pocket expense, such as prescription medication and equipment, should be sent to Risk Management for reimbursement under worker's compensation.
3. IF YOU ARE UNABLE TO WORK AS A RESULT OF YOUR INJURY, NOTIFY YOUR SUPERVISOR. Keep your supervisor informed of your progress and anticipated return to work date. You must provide your supervisor and Risk Management with a doctor's note which authorizes your absence from work.
4. IF YOU ARE ABLE TO WORK PART TIME OR CAN WORK WITH TEMPORARY JOB MODIFICATION please notify your supervisor and Risk Management. A Temporary Modified Duty Work Agreement must be completed. This agreement specifies your doctor's restrictions and temporary work assignment as well as the time period your doctor recommends the restrictions should remain in place.
5. ADDITIONAL FORMS AND CONTACT WITH THE INSURANCE ADJUSTOR may be necessary. Your claim is subject to investigation by the University's insurance adjustor. Complete all requested forms and return them to Risk Management as quickly as possible.
1. COMPLETE THE EMPLOYER'S FIRST REPORT OF INJURY AND SEND IT TO RISK MANAGEMENT AS SOON AS POSSIBLE. Risk Management must send the form to Labor and Industry within 72 hours of the report of injury. As the supervisor, YOU are the employer. The employee has the responsibility to report the injury or illness and assist the supervisor in completing the Employer's First Report of Injury. If the employee is unable to assist you, complete the form to the best of your ability. An employee has six months from the time an injury is known to be work related to report it, one year for an illness (such as carpal tunnel syndrome).
2. COMMUNICATE WITH RISK MANAGEMENT. Call the claims specialist if your employee is unable to work, or when they return to work, following a work related injury or illness. If you have information relative to the investigation of a worker's compensation claim, notify the claims specialist.
3. COMMUNICATE WITH YOUR EMPLOYEE. Ask how they are doing, when they expect to come back to work, and keep them involved with what's happening at work. Statistics indicate this contact with the work place can assist the employee in recovering from an injury or illness.
4. CONSIDER PROVIDING TEMPORARY MODIFIED DUTY WHICH WILL ALLOW YOUR EMPLOYEE TO RETURN TO WORK. Often, an employee who is unable to perform their usual work tasks can work in some capacity. View the necessary work tasks with a creative eye, or identify special projects the employee may be able to work on. Consider allowing your employee to return to work on a part time basis.
Last modified March 14 2016 09:42 AM