Workers' Compensation

Reporting an Injury

1. Injuries must be reported to human resources within 24 hours of the event. The injury should be reported regardless of whether medical treatment is sought or necessary.

2. If possible, the injured party must contact human resources and equal opportunity (HR/EO) to receive, fill out and return the following forms:

                    a. Injury Report

                    b. Medical Release

                    c. Concurrent Employment

                    d. Witness Report (To be filled out by any witnesses)

3. The health and welfare of the injured must be the primary concern. In the event immediate medical assistance is required, the following procedures must be followed:

                    a. The injured party's supervisor must contact and inform HR/EO of the injury.

          b. The injured party's supervisor must obtain statements from any witnesses using the provided form and forward to HR/EO as soon as possible.

           c. The injured party should not present any insurance information to the treating medical facility. Instead, he/she should inform the treating medical facility that the injury is worker's comp related and request the paperwork be filed with the Commonwealth Workers Comp adjuster using the his/her social security number until a claim number is available.

           d. The injured party should submit the required forms to HR/EO as soon as physically able. These forms may be submitted via email attachment to eholt@salemstate.edu or via fax to 978.542.6163 if the injured party is unable to come in.

4. Upon receipt of the requisite forms, HR/EO will file a report with the Commonwealth Workers Comp adjuster and will obtain a claim number which will be communicated to the injured party and must be used when seeking any medical treatment associated with the event.