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Employer's Accident Report Instructions

Entering a New Employer's Accident Report

General form behaviors:

  • Use the "Tab" button to move through the form.
  • Drop down selection fields may be navigated by typing the first letter of the item searched for. The first item in the list starting with that letter will be displayed. It will not recognize additional typed characters. To navigate a long list, switch navigating with the mouse or arrow keys.
  • Time fields will recognize 12 or 24 hour time. If a colon ":" is used, AM or PM designation is required.
  • Pink fields are items that must be completed prior to the second submission by the HR reviewer.

Email address field

  • There is an optional field for addresses in addition to the automatic HR personnel addresses displayed in #3 below. The initial submission email and a second submission notice with form and claim number will be sent these address(s) in addition to the HR personnel.

Employer section

  1. Under the Employer area, scroll down the list and pick your Agency.
  2. If applicable, also pick your Sub-Agency/Department.
  3. Your HR review personnel and email address(s) should appear next to your selection. Verify for accuracy. An initial submission email and a second final submission notice with form will be sent to the address(s).
  4. Employer Case Number: If you have an internal employer tracking number for the accident put it here.
  5. Location: If the incident occurred at a location different from the official employer's address, you may enter it here.

Employee section

  • Complete the personal information for the injured party in this section.

Time and Place of Accident section

  • Provide detail surrounding the time and place of the accident and injury reporting.

Nature and Cause of Accident section

  • In this section, describe in the best detail possible the accident being reported.

Submitting the Employer's Accident Report

  • Click the Submit button. A small pop up window will display "Submitted for Review". Click "OK" to acknowledge.
  • When you submit this report, it will be transferred for further processing by your human resources department.
  • Error Message: "Cannot submit. Please select an Agency before submitting for review."
    • This error will prevent you from submitting. You must select an agency for the form to be directed to an HR reviewer as described above.

For more information

Contact the university's workers' compensation coordinator at 540-231-3463.