UTMB / HR Employee Injury Management What to do for. . .

What To Do In Reporting On-the-job Injuries

Employee

Report the injury/illness to supervisor and the Employee Injury Management Office by calling (409) 772-1892.
Obtain an Employee Injury Statement Form from your supervisor.
Complete the form and have your supervisor sign and date it.

If first aid/medical care is needed, take competed form with you to the Employee Health Clinic (M-F, 7:30 am - 4:30 pm), Urgent Care Clinic, Unit Infirmary or any physician approved to treat workers' compensation injuries. (Note: If follow-up medical care is desired by employee's choice of treating physician, please contact the Employee Injury Management Office).

Ask medical care provider to complete bottom portion of form regarding work capabilities.

Completed form is returned to supervisor.

Supervisor

Have employee complete Employee Injury Statement Form

Review form for completeness.

Sign and date form, which indicates when the employee reported the injury and what occurred.

Inform employee to call Employee Injury Management Office, (409) 772-1892.

Submit completed form to the Employee Injury Management Office, Route 0818.

What To Do If You Need a Temporary Job Modification

Employee

Inform supervisor of problem(s) performing job task(s) due to a medical condition and desire to continue working.

Complete and sign "Request for Temporary Job Modification Form"

Provide documentation from physician, "Physician's Work Certification"

Work cooperatively with department and Return to work Coordinator toward resolution of request.

Supervisor

Provide employee with "Request for Temporary Job Modification Form."
Offer to assist employee in completing form.

If longer that seven days, inform employee that medical documentation is needed.

Sign, date, and check either "Yes" the modification requested is acceptable to the department or "Further Review Requested".