Employee Duties Regarding Occupational Injuries or Illnesses

Your Role - Before an Injury

1. Follow safe working practices. 
2. Discuss any unsafe working conditions or practices with your supervisor. 

Your Role - After an Injury

1. Notify your supervisor immediately. 
• Report all injuries, no matter how minor or temporary they may seem to be.
• If you witness an injury that prevents a co-worker from moving or speaking, immediately inform your supervisor. 
2. Get triage. 
• Help your supervisor determine what kind of care you need by describing your injury.
• Triage includes an initial injury report with our (select what applies to your company: on-site nurse / clinic / nurse call center).
3. Seek prompt medical attention. 
• Emergencies – call 911 and go to the ER by ambulance. Examples of emergencies include loss of blood, heart attack, blunt force to the head, severe burns and electric shock. 
• Non-emergencies – during triage, your supervisor and/or nurse will help you determine the most appropriate medical care for your particular injury.
• Our company has an on-site (insert name of the nurse/clinic, if applicable).
• Our company has established a relationship with a (insert name of the doctor/clinic, if applicable).
4. Report the injury. 
• Help your supervisor complete the required paperwork, including the Report of Injury or Illness form. 
• Throughout your recovery, update your supervisor on your progress after doctor visits and save any paperwork you receive. 
• Work with your doctor and supervisor to find ways to return to work during the recovery process. 

Your Supervisor’s Role

You can expect from :

1. Training and Communication 

• Your supervisor will direct you toward updated information on how to handle injuries and deal with the medical and insurance policies and processes.
• Your supervisor will communicate with you immediately after an injury and follow up regularly with you as you recover. 

2. Timely Reporting

• Your supervisor will begin the insurance claims process within 24 hours of learning of your injury.

3. Medical Care

• Your supervisor will help you access appropriate medical care.
• Your supervisor will discuss your return to work with your doctor, if appropriate.

4. Accommodations for Return to Work

• Your supervisor will work with your doctor’s recommendations to get you back on the job as soon as possible. 
• Your supervisor will act quickly to allow you to return to work in a way that will facilitate healing.
  
  

Insurance and Workers’ Compensation

You may qualify for different types of benefits, based on the type and severity of your injury: 

• Sick Leave
• Paid Leave
• Temporary Income Benefits
• Family Medical Leave
• Short-Term Disability
• Long-Term Disability

Through ’s workers’ compensation insurance, you will receive benefits, including medical care, if you were injured at work while performing work duties. Here are a few facts about workers’ compensation:

• You may receive short-term disability leave payments if your injury causes you to lose work more than (define your company’s short-term disability rules here).
• You can receive workers’ compensation no matter who was to blame for the accident.
• If you have questions about workers’ compensation or other benefits, talk to our (select your company’s workers’ compensation point person: Injury Management Coordinator / HR / your supervisor).  

Talking to your Doctor

1. You can visit any doctor, even one whom the company does not have an established relationship with. 
2. Ask questions. Some helpful questions to ask are:

• What is the name of my injury and what caused it?
• How will I heal? How long will recovery take? How will I feel tomorrow, next week, or next year? 
• What can I do to feel better until I recover?
• How can I prevent this injury from getting worse or happening again?

    3. Help your doctor determine how best to help you recover at work:

• Bring to your appointment a description of your job duties. 
• Describe your work and work environment to your doctor. 
• Mention that your company will fully support you with modified work duties or any necessary accommodations as soon as the doctor approves it. 

    4. Discuss follow-up visits, if needed. 

• Find out whether you will need to see the doctor again before returning to work.
• If you need follow-up visits, try to schedule them outside of work hours.

    5. Get any necessary forms signed by the doctor. 

• If your injury will result in any missed days from work, you will need to have your doctor fill out and sign a Return to Work form.
• Your doctor’s signature is also required (fill in the names of any necessary forms your company requires).

I have read the company policy regarding occupational injuries and illnesses and it has been explained to me in a language I comprehend. I understand my responsibilities and duties as they relate to reporting workplace incidents. I have been given a copy of this statement.

Employee Signature:

Employee Name (print):

Date: