Instructions for Injured Employee

Read First

Supervisor must submit the Supervisor's Report of Injury, Incident, or Illness prior to proceeding.

Instructions

Notify your supervisor immediately when an incident, injury, or exposure to an occupational disease occurs in the course and scope of your job.
Notify supervisor or Worker's Compensation Specialist at once if medical services are needed due to work-related injury or illness. Do not pay for any medical services.
If lost time from work occurs, the employee must inform their supervisor that they are off work due to a work-related injury. The employee is required to meet with the Worker's Compensation Specialist to complete an election form as soon as lost time begins. Do not return to work before clearing with the Worker's Compensation Specialist. The University requires a medical release to return to work.

Secondary Forms for Injured Employee

Once the supervisor report has been filed with EHSREM, the employee will need to complete some secondary forms. Depending on the situation, some forms may not be required. Please contact the Worker's Compensation Specialist before proceeding.

Employees Report Of Injury_SORM29 (PDF, 497KB)

Employee Report of Injury_SORM29 Spanish (PDF, 712KB)

Authorization for Release of Information_SORM16 (PDF, 59.8KB)

Authorization for Release of Information_SORM16 Spanish (PDF, 160KB)

Employees Election of Time_SORM80 (PDF, 195KB)

Employees Election Of Time_Spanish_SORM80 (PDF, 257KB)

Acknowledgement-Form-English (PDF, 107KB)

Acknowledgement-Form-Spanish (PDF, 80.7KB)

Employee-Notice-of-Network-Requirements-English (PDF, 426KB)

Employee-Notice-of-Network-Requirements-Spanish (PDF, 249KB)

Medical Reimbursement Request Form_SORM81-A (PDF, 319KB)

All forms need to be submitted via TXST File Transfer