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Forms

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After an accident, the following forms may be necessary to process workers’ compensation claims.

• Supervisor’s Injury or Illness Investigation Report (pdf)

• Employee Accident Statement Form (pdf)

• Witness Accident Statement Form (pdf)

Clinic Passports

If the accident requires medical attention, the injured employee should visit the primary care facilities designated by the University. Treatment cannot be administered without the following forms, either brought into the appointment or faxed prior to the appointment.

• Omega Clinic Passport – Evanston (pdf)

• Corporate Health Clinical Passport - Chicago (pdf)

Lab Injury Protocol

Hang this up in your lab for a quick reference guide on what to do if someone gets injured.

• Evanston Campus Labs  (pdf)

• Chicago Campus Labs  (pdf)