Injury Reporting Protocol
In the case of a life-threatening emergency, immediately contact Campus Police at 9-1-1 or 919-515-3000 to dispatch emergency services.
In the case of a non-life threatening emergency, notify a supervisor or manager immediately. The supervisor or manager will assess the situation, help arrange for proper medical care and begin the injury reporting process. It is important to report a work-related injury, accident or illness immediately, no matter how insignificant the incident may seem, as oftentimes those that get overlooked turn into larger medical problems.
The link to the current forms for reporting an accident is Reporting Accidents & Worker’s Compensation
It is critical that all accidents be reported the same day as they occur and forms are submitted to CE HR within 24 hours.
Steps to report an occupational injury, illness, first-aid case, or near miss incident:
Supervisor’s Responsibilities
Supervisor should ensure the injured employee receives prompt medical attention
Supervisor should complete the NC State Supervisor’s First Report of Incident form. Answer all questions. Use a separate form for each injured employee.
If employee is seeking medical attention, the Supervisor should complete Part A of the Supervisor’s Medical Treatment Authorization Form, and send the form with the employee for the physician to complete. The employee should bring back the completed form.
Supervisor should call one of the approved medical facilities listed on the Authorization form, before sending the employee for treatment. The employee must use one of the authorized facilities unless pre-approved.
Send all completed forms, including the physician’s instructions to Linda Marciniak at l_marciniak@ncsu.edu.
Employee’s Responsibilities
Employee should complete the Workers’ Comp Employee’s Statement Form. This form only needs to be signed by supervisor if supervisor assists in the completion.
Employee should complete the Workers’ Comp Use of Leave Option Form. (Only required for SHRA/EHRA employees)