RM0001: Employee Injury Report

To report employee injuries or occupational diseases

Department: Risk Management
Last revised: 8/2019
Where available: On line
Form Type: Interactive
File Type: Acrobat PDF Form

RM0002: Declination of Treatment for Work Related Injury

Employee's record of declining treatment for a work-related injury

Department: Risk Management
Last revised: 8/2019
Where available: On line
Form Type: Print and Fill
File Type: Acrobat PDF Form

RM0005: Release to Return to Work for Workers' Compensation

Physician's recommendations for return to work for Workers' Compensation

Department: Risk Management
Last revised: 7/2017
Where available: On line
Form Type: Interactive
File Type: Acrobat PDF Form

RM0006: Verification of Work Restrictions Form

Supervisor's agreement with injured employee about restrictions

Department: Risk Management
Last revised: 8/2019
Where available: On line
Form Type: Interactive
File Type: Acrobat PDF Form

RM0007: Workers' Compensation Mileage Form

Recording mileage for trips necessary as a result of work-related injury

Department: Risk Management
Last revised: 07/2020
Where available: On line
Form Type: Interactive
File Type: Acrobat PDF Form

RM0013: Bloodborne Exposure Incident Report

To report exposure with blood or other potentially infectious material

*

Department: Risk Management
Last revised: 07/2020
Where available: Online
Form Type: Interactive
File Type: Acrobat PDF Form

RM0014: Bloodborne Exposure Incident Report Declination of Medical Assessment Treatment

For staff to decline treatment after a bloodborne exposure incident.

*

Department: Risk Management
Last revised: 07/2020
Where available: Online
Form Type: Print and Fill
File Type: Acrobat PDF Form

RM0015: Hepatitis B Request/Declination

Option for Hepatitis B Vaccination

Department: Risk Management
Last revised: 8/2019
Where available: On line
Form Type: Print and fill
File Type: Acrobat PDF Form

RM0026: Claim Form for Replacement of Personal Items

*

Department: Risk Management
Last revised: 8/2019
Where available: Online
Form Type: Print and Fill
File Type: Acrobat PDF Form

RM0035: Release to Return to Work-Mental Health Issues

Doctor's documentation for employee return to work - mental health issues

Department: Risk Management
Last revised: 2/2025
Where available: Online
Form Type: Print & Fill
File Type: Acrobat PDF Form

RM0036: Release to Return to Work (Excluding Workers' Compensation)

To be completed by treating physician prior to returning to work

*

Department: Risk Management
Last revised: 2/2025
Where available: Online
Form Type: Print and fill in
File Type: Acrobat PDF Form

RM0040: Vehicle Collision Report Form

*

Department: Risk Management
Last revised: 8/2015
Where available: Online
Form Type: Print and Fill
File Type: Acrobat PDF Form