Workers’ Compensation Procedures

1. Incident Checklist – This should be filled out by either the nurse, principal, or immediate supervisor.
2. Employee Injury Report – This should be filled out by the employee ASAP. This form does NOT go home with the employee to be filled out. If the employee is not able to fill it out then the nurse, principal, or immediate supervisor will need to help the employee fill it out.
3. Notice to Medical Provider – This form needs to be filled out by the nurse, principal, or immediate supervisor and signed by the employee.
4. Immediate Supervisor Report – This form needs to be filled out by the employees immediate supervisor (this may vary ex. Principal, Cafeteria Manager, Director, etc.)
5. Witness Report – This form needs to be completed by anyone who witnessed the incident happen.

The injured employee should receive a copy of forms 2 and 3.

A file has been created with these forms on Google Drive. You will need to be signed into your crosbyisd.com e-mail to be able to view the forms. The link is: https://drive.google.com/drive/folders/1a4FC653hb0O0GNiLRAjaiwANEhXaeffI?usp=sharing

Every campus Nurse, Principal, Principal’s Secretary, Cafeteria Manager, and Head Custodian as well as the directors (just in case) should have access to these forms.