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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

RM0004: Employee's Choice or Change of Doctor Form

Statutory rights to choose doctor to treat work-related injury

Department: Risk Management
Last revised: 8/2016
Where available: On line
Form Type: Interactive
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: Print and fill in
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: 8/2019
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: 8/2019
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: 8/2019
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

RM0019: Student Incident Report

Use to report student injuries

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

RM0020: Student Incident Investigation Report

Record of investigation after student injury

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

RM0023: Patron Incident Report

To be completed for all non-student/non-employee injuries

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

RM0026: Claim Form for Replacement of Personal Items

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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: 7/2017
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: 7/2018
Where available: Online
Form Type: Print and fill in
File Type: Acrobat PDF Form

RM0040: Vehicle Collision Report Form

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