General Information
Employee's Responsibility:
Only duty is to report the injury to the supervisor and the Workers' Compensation Program
- Who was the injured
- When did it happen
- Where did it happen
- How did it happen
Supervisor's Responsibility:
- Checks injury to see if the employee needs medical care
- Makes an initial inquiry/investigation
- Determines if witness were present
- Ensures that a Report of Injury form is completed immediately
- Files the Report of Injury form with the Workers’ Compensation Program
Required Documents/Forms include but are not limited to the following:
- Report of Injury form
- Navajo Nation Vehicle Accident form (if applicable)
- Accident or police Report
- Travel Authorization
- Witness statements
- Personnel Action Forms
- Job descriptions
- Shift, weekly, or monthly schedules
- Official time sheets for the period of disability
- Authorization for disclosure of medical information
- Doctors’ statements
- Medical return to work statements
- Medical records
- Medical referral notices
Forms
Title
General Information (PDF)
