Work Injury

 Employee Injury Report Form

 Work Related Illness or Injury Form

Both forms above are to be completed within 24 hours by ESC staff members if injured while at work according to your assigned calendar.  Please thoroughly complete all three pages in both forms no matter how minor you believe the injury to be.  Alert your supervisor to the injury and forward the original form to the Business Office immediately.

Injury Reporting Packet- Information Necessary When Medical Attention Sought

In addition to the above reports, this packet is needed when an employee needs medical attention for an injury sustained while at work.  The form titled First Report of an Injury, Occupational Disease or Death should be completed and given to your doctor, urgent care or emergency room.  Included is also a copy of our Bureau of Workers Comp Policy information so that the claim can be processed through CareWorks.  Please be sure to give this information to the medical provider rather then your personal insurance information.

© 2013 Northwest Ohio Educational Service Center | 205 Nolan Parkway, Archbold, OH 43502 | (567) 444-4800