Employee Work Injury and Illness Report

The Employee Work Injury and Illness Report is intended to document situations and / or events that led to a work-related injury or illness.

If you sustain a work-related injury or illness:

1. Seek immediate first aid and/or medical treatment, as necessary. Inform your medical provider if you sustained a work-related injury or illness.
2. Notify your supervisor of any unsafe working conditions.
3. Report the occurrence / incident to your supervisor by completing one of the following forms within 24 hours.

(E-App) Employee Work Injury and Illness Report (for Facilities, Planning & Management (FP&M) Employees Only). This E-App will be strategically released to each department in 2026-27

• Upon submission, your supervisor will receive an email indicating a work-related injury or illness has occurred. Your supervisor will be instructed to complete the (E-App) Supervisor Incident Analysis and Prevention Report within 1 workday.
• (PDF) Employee Work Injury and Illness Report (for all other university departments not listed above).
  • Submit this report to your supervisor. Your supervisor will then complete the Supervisor Incident Analysis and Prevention Report (PDF).
  • Your supervisor will submit both completed reports to your Divisional HR Representative within 1 workday.

Workers’ Compensation claims are coordinated through the Office of Risk Management Workers’ Compensation Coordinator, in partnership with the Divisional Human Resources Representatives. For additional information, please visit: Division of Business Services – Workers’ Compensation.