The Worker’s Compensation procedures are outlined on the main HR website here: Worker's Compensation
In the case of a life-threatening emergency, immediately contact Campus Police (919-513-3333) to dispatch emergency services, or 911, if outside the Raleigh area.
As soon as an incident occurs, the supervisor on duty should e-mail firstname.lastname@example.org to make the University Benefits Department aware of the incident.
A list of medical treatment providers can be found here: Hurt at Work.
Please read these procedures and familiarize yourself with them. If this is for a student, in a “student capacity” they will need to go to Student Health Services. If the student is “working in a paid temp capacity” follow the same procedures as you would for staff. If the incident/injury happens after hours, then the employee should go to the emergency room.
All the forms are found on the main HR website: HR Forms. The Employee Statement and Leave Options forms are found here: Worker’s Compensation Forms (for faculty and staff) while the remaining forms are found here: Worker’s Compensation Forms (for departments) Additionally, all the forms can be found in this document. All of these forms are “form fillable” so if possible and time allows, please complete online and then print them out.
For all injuries/incidents that fall under the “Receive First Aid Only” and “Have a Near Miss/Return to Work” the following paperwork MUST be filled out:
- First Report of Injury
- Employee Statement ** Please note that the supervisor only signs this if they (the supervisor) filled the form out for the employee, otherwise do not sign.
- Leave Options Form
For all injuries/incidents that require “Medical Attention” the following paperwork MUST be filled out:
- Employer’s Report of Injury or Occupational Disease to the Industrial Commission; aka “Form 19”
- Physician’s Report & Pharmacy Guide (Raleigh area)** Please note that this form must accompany the employee to the Urgent Care Facility and we need to have it back or a copy of it to forward to campus.
- Physician’s Report & Pharmacy Guide (Outside Raleigh area) Please note that this form must accompany the employee to the Urgent Care Facility and we need to have it back or a copy of it to forward to campus.
As well as all of the above forms; “First Report of Injury”, “Employee Statement”, and “Leave Options Form”
All injuries/incidents that involve an animal bite:
Animal Bite Form
Located on the Hospital Shared Drive->SOPs & Forms->VHC Forms
(G:\Shared\Hospital\SOPs & Forms\VHC Forms)
All other forms are to be turned in to the designated CVM-HR staff member ASAP. Failure to turn these within a reasonable amount of time (preferably 24 hours) could result in problems for the employee with billing issues.