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EMPLOYER'S REPORT OF OCCUPATIONAL INJURY OR DISEASE
A web-based electronic form is used to report on-the-job injuries to the University's Workers' Compensation Insurance Carrier and Pennsylvania's Bureau of Workers' Compensation. This form must be completed by the injured employee's immediate supervisor/manager or department head.
This form must be completed no matter how slight the accident may seem.
The Employee's Report of Occupational Injury or Disease form is a web-based electronic form accessed through the following link, https://workserv.ohr.psu.edu/WorkersComp/user/Session/frmEnterId.cfm through the OHR-Workers' Compensation website, http://ohr.psu.edu/workers-compensation/
First Report of Injury Instruction, http://ohr.psu.edu/assets/workers-compensation/documents/FirstReportOfInjuryInstructions.pdf
Medical Treatment The injured worker must choose a Health Care Provider Panel participant for the first 90 days of treatment in order to ensure that the University will pay for medical treatment.
Emergency Treatment If the injury results in an immediate medical emergency, initial medical assistance may be obtained from the nearest hospital. However, follow-up care must be from a Health Care Provider Panel participant.
Instructions:
Click on link https://workserv.ohr.psu.edu/WorkersComp/user/Session/frmEnterId.cfm
Enter your University access ID and Password
Enter Injured worker's ID number
All field marker with an * must contain information or the form cannot be submitted
Demographic information automatically populated by IBIS
Use drop down windows for Dependents; Date of Injury; Time employee began work; Time of Occurrence; Date last worked; Date Employer notified; Date Disability began; Date Returned to work
Work Unit Contact should be injured worker's direct supervisor
Use drop down windows for Type of Injury, Part of Body Affected, Cause of Injury
Enter text in Description Fields. Type of Injury or Illness, Parts of Body Affected, and Cause of Injury (Be as precise as possible)
Complete the narrative boxes to describe what the employee was doing at the time of injury and what happened to cause the injury
Use drop down window to click on your work unit
Select Provider of Initial Medical Treatment
Physician/ Health Care Provider (Complete as many fields as possible )
Witness Information (If applicable include the name and telephone number of witness) (If no witness leave blank)
Review all entries before you hit "Submit This Form" ONCE SUBMITTED YOU CANNOT GO BACK AND CHANGE FORM
Please complete the forms below: