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Workers Compensation

CONTACT: Jodi Anthony, (920) 424-2070, anthonyj@uwosh.edu

Fax: (920) 424-2021

The Worker's Compensation Act of Wisconsin provides coverage when, the employee is performing service growing out of and incidental to his or her employment, and sustains an injury as a result of that service.

The employee and supervisor MUST complete paperwork in full and return it to Human Resources within 3 days of the injury. Contact Jodi if you are unable to send documents to Human Resources within the above timeframe.

Notice has been given that the Worker's Compensation division will be closely monitoring that campuses are in compliance with paperwork processing. Fines will be issued and charged directly to departments if compliance is not met.

If it is an emergency, do not hesitate to go to the emergency room. Supervisor may contact Human Resources directly to report the injury.

The following steps should be taken when a faculty, staff member or student worker is injured while performing job responsibilities:

Employees

It is your responsibility to report the injury to the supervisor on duty the day/time the injury occurs.

The Employee injured should complete the "Injury and Illness Report" and submit it to his or her chair/supervisor. http://www.uwsa.edu/oslp/wc/forms/OSLP-1EmpForm.doc

Supervisors

It is your responsibility to ensure that the Employee's First Report AND the Supervisor Analysis and questions are given priority when an injury occurs.

The Chair/Supervisor must complete the "Supervisor's Accident Analysis and Prevention Report" and answer the questions below.

Click here for the Supervisor's Analysis Report with questions to answer.

Supervisor Questions to Answer:

  • What time of day does the employee start work?
  • How many hours per day does the employee work?
  • How many hours per week does the employee work?
  • How many days per week does the employee work?
  • Are there any other part-time workers within the same department doing the same work with the same schedule? If yes, how many?
  • Within the same department, what are the number of full-time employees doing the same type of work?


Send both signed and dated forms, along with answers to the supervisor questions, to Human Resources, Dempsey Hall 328, within 3 days of the injury. If need be, fax the paperwork to 424-2021 before sending originals to Human Resources.

UW System policy requires all forms to be submitted to the Office of Safety and Loss Prevention within 7 days of the injury date, thus, UW Oshkosh Human Resources requests forms to be submitted within 3 days of the injury to allow for questions and data entry.

If it is a work related death please contact Human Resources immediately. It must be reported to the Department of Workforce Development within 24 hours.

NOTE: Please complete the forms as thoroughly as possible to avoid delays in processing.

All Physician Return to Work forms and reports should be forwarded to Human Resources upon receipt.

These forms will indicate the date a faculty/staff member may return to work with or without restrictions and must be filed with Human Resources. For each physician visit, a return to work form should be submitted including if the diagnosis is to return to work with no restrictions.

Physician documentation and return to work forms should be submitted to:

Jodi Anthony, Human Resources, UW Oshkosh
800 Algoma Blvd, Oshkosh WI 54901

Fax Number: (920) 424-2021

Timecard/Leave Reporting should indicate any lost time due to a work related injury.

If lost time occurs, it is important that the timecard/leave report indicate those days off of work. Jodi will assist with how time should be recorded on the timecard/leave report on a case-by-case basis.

If, due to the injury, the chair/supervisor or employee are unable to complete the forms within the 3 days immediately contact Jodi (424-2070) to inform her of the details of the injury.

This is especially important for injuries causing lost time or requiring medical treatment beyond first aid. If reports of injury are reported late to the Office of Safety and Loss Prevention, the department may be responsible for paying for fines related to worker's compensation requirements.

Upon receipt of the injury reports, Human Resources will review for completeness and submit to the Office of Safety and Loss Prevention. The UW Oshkosh Safety Coordinator will review all injury reports for evaluation of safety practices on campus.

The UW System Worker's Compensation Coordinator will contact the employee injured with details of the claim. Jodi will be the liaison between the Office of Safety and Loss Prevention and the employee. If you should have any questions or concerns regarding claims, please contact Jodi.

For further information regarding Worker's Compensation, please visit the Office of Safety and Loss Prevention website at: http://www.uwsa.edu/oslp/wc/

Worker's Compensation Forms:

Think Safety First!

CONTACT:
Jodi Anthony
WC Coordinator
UW Oshkosh
(920) 424-2070
Fax: (920) 424-2021
anthonyj@uwosh.edu

Fall View
 

Adobe Acrobat Document = Adobe Acrobat Document
Word Document = Microsoft Word Document

After printing & filling out forms, please return them to:
Human Resources, Dempsey 328
 

Questions about the website? Contact Becky Beahm at beahm@uwosh.edu

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