Text Options for the Visually Impaired Font Size: a- A+ Color: A A A Revert 
Close vision bar
Open vision bar

Workers' Compensation

 

Frequently Asked Questions (FAQs) about Workers' Comp Claims from our Workers' Comp Provider, KEMI

 

EVERY FORM AN EMPLOYEE SHOULD NEED IF THEY EXPERIENCE A WORKPLACE INJURY

WORKERS' COMP FIRST REPORT OF INJURY FORM - If you experience a workplace injury, this form must be completed and faxed to both KEMI and SCS as soon as possible following the injury.  Your Workers' Comp contact within your school/department will be able to assist you.  

WHEN COMPLETING THIS FORM, PLEASE:

          1. Pay special attention to include the SCHOOL NAME in the "Department or Location where incident or illness occurred."

          2. Check one of the boxes regarding the type of "Initial Treatment" you received.  This is critical.  

          3. The person that experienced the injury MUST sign the bottom of the second page of this form.  

 

PHYSICIAN'S FORM

 

MEDICAL WAIVER AND CONSENT FORM

 

RETURN TO WORK FORM - If you are seen by a physician as a result of a workplace injury, you MUST get this form completed by the physician that saw you prior to returning to work.  

 

TEMPORARY PRESCRIPTION CARD (TMESYS)

 

For more information, contact Billy Parker at 502-863-3663.