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Workers' Compensation Accident Report Form
Jul 15,2016 at 11:36:AM

Any employee who sustains a job-related injury or illness is to report the incident immediately to the supervisor who files a Supervisor's Report of Injury form with Risk Management within 24 hours. Risk Management is responsible for supervising the program, including the initial investigation of claims. Processing indemnity checks and medical payments is the responsibility of PMA under direct supervision of Risk Management. All claims are subject to review by the Workers' Compensation Board. Please complete the form and forward to Risk Management with original signatures. Instructions are on page 2.

The Statement Of Rights is also attached and should be printed off and given to the employee at the time the accident report form is completed.

Statement of Rights





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