Workers’ Compensation Checklist

When an employee reports a workplace accident, please complete the following steps (click the links to access the forms):

Click here to print a copy of this checklist

  1. Supervisor must complete the First Report of Accident (FRA)
  2. The injured employee must complete a drug test before the end of their shift when the accident happened. Even if the accident has been reported to you after the date that it happened, your employee must complete a drug test as soon as possible. Click for Drug Test Locations and Contacts
  3. Print and provide Designated Provider List to the injured employee. The employee and the supervisor must sign and return to
  4. Print and provide Prescription Information for injured employee. If they are prescribed medication, they must call the number provided and complete the form on the bottom of the page. The employee then provides the information on the form to the pharmacy to pick up their prescription. The form is available in English and Spanish
  5. Provide Employee Statement to the employee – once completed please return signed copy to
  6. Complete Incident Analysis with the injured employee. This can be completed at a later date after you and the employee have had time to reflect on the incident. The goal of this analysis is to identify contributing factors and help avoid a similar incident in the future. Please refer to this guide for completing the incident analysis.
  7. If the injury is “report only”, meaning the employee will not seek medical treatment immediately, follow up with them for 3 days after the incident to check to see if they are going to see a doctor. If after 3 days they still do not wish to see a doctor, please print and have the employee complete the 3 Day Injury Follow-Up Form. By completing and signing this the employee is NOT waiving any rights to see a doctor down the road. This form is a requirement that shows that we made the employee aware that they had the option to see a doctor after their injury.

First Report of Accident Form

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