Workers Comp

1. To be completed and signed by the supervisor after a reported workers comp accident or injury.

2. Completed report should be sent to Christine D'Agostino at the Board Office, within 48 hours, along with a completed Employee Report (below).

1. To be completed by the employee immediately following an accident or injury.

2. Completed report should be sent to Christine D'Agostino at the Board Office, within 48 hours, along with a completed Supervisor Report (above).

The nurse should give one of these to any employee who reports a WC accident or injury.

1. For school nurses, secretaries, building and evening supervisors and principals.

2. Outlines the procedure for reporting and recording WC injuries.

1. For school nurses, secretaries, building and evening supervisors, principals, or anyone who sends an employee with a work related accident or injury to a hospital emergency room.

2. This form must be used any time an employee is taken to a hospital emergency room. It should be completed and given to the registration desk in the ER so that billing goes to the correct party.

1. For school nurses, building and evening supervisors, or anyone who calls in a work related accident or injury to First MCO.

2. This is an optional form used to gather the necessary information prior to calling First MCO to report an injury.

1. If an employee refuses to go to an approved WC physician/facility (i.e, they insist on going to their family physician), they need to sign this form.

2. Signed forms should be sent to Christine D'Agostino at the Board Office.