Workers' Compensation Program Filing Procedures

Read these procedures before clicking on the link to the form you need. Links to the Workers' Compensation Forms are given below the following information.

EMPLOYEES RESPONSIBILITY IN THE EVENT OF A JOB-RELATED INJURY OR ILLNESS

  • Report all injuries or illness to your supervisor immediately.
  • Seek appropriate medical attention from the following authorized primary care physicians:
    ASU Student Health Services
    Watauga Medical Center Emergency Room

NOTE: In case of a life-threatening emergency, go to the nearest medical facility.

  • Contact Watauga Medics at 9-911 for emergency transportation to Watauga Medical Center Emergency Room. For non-emergency transportation to ASU Student Health Services or Watauga Medical Center Emergency Room, contact University Police at ext. 8000 or 2150.
  • Return to work after your medical treatment unless your authorized physician provides you with a written authorization prohibiting your return to work.
  • All medical notes given to you at medical treatment should be given to your supervisor for submittal to the Workers' Compensation Administrator.
  • Provide a doctor's note to your supervisor stating any medical restrictions placed upon you as a result of the work-related injury.
  • Follow all medical restrictions; your recovery is a major concern to the University.
  • Provide the completed Employee's Accident Report Form with details of the accident to your supervisor.
  • NOTE: Be sure to contact Human Resource Services with questions regarding payment and/or continuation of employee benefits. Refer to the "Continuation of Benefits" section in the State of North Carolina Workers' Compensation Employee Handbook for additional information.
  • Adhere to any transitional duty assigned to you as a part of the University's Return to Work Program.
  • Keep supervisor notified of any changes in medical condition or any concerns in reference in your case.
  • Follow safe work practices!

SUPERVISOR'S RESPONSIBILITY IN THE EVENT OF A JOB-RELATED INJURY OR ILLNESS OF AN EMPLOYEE

  • Ensure that the injured employee receives immediate and appropriate medical attention.
  • Direct the employee to one of the authorized primary care facilities listed above, unless it is a life threatening injury.
  • If able to do so safely, employees should transport themselves for treatment. If they are not able to do so, contact Watauga Medics at 9-911 for emergency transportation to Watauga Medical Center Emergency Room. For non-emergency transport to ASU Student Health Services or Watauga Medical Center ER, contact University Police at ext. 8000 or 2150.
  • Report the injury immediately to the Workers' Compensation Administrator, Wanda Yates, 262-4008.
  • Investigate all injuries as soon as possible after the incident occurs. Use the Supervisor's Accident/Illness Investigation Form listed below. Forward the names and reports from any witness that may have seen the incident, along with Workers' Compensation forms, to Safety & Workers' Compensation Office within 24 hours of the incident or as soon as possible.
  • Complete the required documentation ( Employee's Accident Report Form, Supervisor's Accident/Illness Investigation Form, ASU Treatment and Return to Work Authorization Form, and Medical Records Release Form) and forward to the Safety & Workers' Compensation Office within 24 hours of the incident or as soon as possible.
  • Correct unsafe conditions immediately.
  • Maintain weekly contact with injured employee to ensure their needs are met. Keep employee notified of any departmental changes while employee is out of work.
  • NOTE: Refer employees to Human Resource Services if they have questions regarding payment and/or continuation of employee benefits. Refer to the "Continuation of Benefits" section in the State of North Carolina Workers' Compensation Employee Handbook for additional information.
  • Identify and notify the Workers' Compensation Administrator of modified, transitional duty available in your department. Assign transitional duty work as soon as the employee is medically able to return to work.
  • Notify the Workers' Compensation Administrator if employee indicates a change in medical status or condition, or employee indicates absence is related to the injury.
  • Encourage safe work practices!

NOTE:: Click on the following link to access an Employee Responsibilities and Checklist.

NOTE: Click on the following link to access a Supervisor's Responsibilities and Checklist.

The University works with Key Risk Management Services, 3rd Party Workers' Compensation Claims Manager. If you have questions about your claim call Wanda Yates at the Safety & Workers' Compensation Office, ext 4008

WORKERS' COMPENSION FORMS:

Employee's Accident Report Form (Non-interactive Fields; print and complete form)
Supervisor's Accident/Illness Investigation Form (Non-interactive Fields; print and complete form)
ASU Treatment and Return to Work Authorization Form (Non-interactive Fields; print and complete form)
Medical Records Release Form (Non-interactive Fields; print and complete form)


ASU Accident Report Form - Used for non-work related injury or illness (Interactive Fields)
Workers' Compensation Employee Handbook

Medical Transportation
Safety Office | Business Affairs Annex, State Farm Road | Phone: 828.262.6120 | Disclaimer