Worker's Compensation
The Worker's Compensation Program at the Office of the Chancellor is a no-fault insurance program that pays benefits for employees who sustain work-related injuries or illnesses. Meaning: the condition must be caused, aggravated or accelerated by work activities or the work environment.
EMPLOYEE RESPONSIBILITIES:
- Promptly report injuries to supervisor and/or Human Resources
- Provide all necessary and applicable information
- Work with supervisor and Human Resources on absences and Return to Work
- Compete timely and accurate timesheets
INCIDENT REPORTING PROCEDURE
All employees who sustain an injury while performing the duties of their position should:
- Immediately report any workplace incident or injury to your supervisor.
- Complete a First Report of Injury Form and fax to (651) 297-3145.
- If you have any questions contact Nicole Gebheim in Human Resources at (651) 297-3791 or Nicole.Gebheim@so.mnscu.edu.
- For questions about general safety in your physical workspace, please contact Keswic Joiner at (651) 297-4686 or Keswic.Joiner@so.mnscu.edu.
FORMS & ADDITIONAL INFORMATION
The following forms are to be completed and submitted as soon as possible but no later than 24 hours to your agency Worker's Compensation Coordinator:
- Supervisor's Injury/Illness/Incident Reporting & Worker's Compensation Checklist
This check list identifies the critical steps Supervisors must take to report a work related injury, illness or incident. The checklis references the forms found below.
- Information Privacy Statement
This form should be given to the injured worker PRIOR to collection of any data needed to fill out and file a First Report of Injury (FRI). This form is used to ensure compliance with the Minnesota Government Data Practices Act.
- Employee Statement Regarding Injury/Illness
This form is to be completed by individuals reporting an injury, illness or incident. Supervisors should have the person reporting the incident complete the form as soon as possible after the incident. Supervisors must also complete the Injury/Illness/Incident Data Form.
- FRI Injury/Illness/Incident Data Form (IDF)
This form replaces the old First Report of Injury (FRI) and is used to collect the necessary information regarding an injury, illness or incident that may be work related.
- Agency Claims Investigation Form
This form is used by the supervisor to conduct an investigation of the injury, illness or incident. The investigation should identify contributing factors that permitted the event to occur and should identify actions that will be taken to prevent reoccurrence.
Additional forms and information pertaining to Worker's Compensation can be found at the following link:
http://www.risk-workerscomp.admin.state.mn.us/forms.htm
