Go to all Forms
If you have questions about information presented here, please contact:
- Christine Steggs: email@example.com, 402-472-8120
- Accident/Injury/Illness Forms Posted: 1/26/2012
Description: If an employee has a paid appointment with the University, he or she and the supervisor need to complete the necessary forms as soon as possible after a work-related injury or illness occurs and fax it to the UNL Benefits Office at 402-472-3101.
Contact: Christine Steggs
Contact Information: 908 HARH, EC 0989 Phone: 402-472-8120
Additional Information and/or Instructions:
Forms to be completed include:
- First Report of Occupational Injury or Illness (form on page 1)
- Workers' Compensation Incident Report (form on page 2)
- Employees's Choice or Change of Doctor (form on page 3)
- Release to Return to Work (link at the bottom of the page, opens as a Word document)
Emeritus faculty*, retired staff, visitors, guests, and students** are not eligible for Worker's Compensation. If they are injured while on University property, they must use their personal funds/insurance to cover any medical expenses.
* Emeritus faculty who sustain a work-related injury or ilness while doing a paid assignment for the University will qualify for worker's compensation.
** Students who are employees and sustain a work-related injury or illness will qualify for worker's compensation, for that specific injury or illness. If they are injured while walking to class, that injury is not covered under worker's compensation.
Additional information may be found at http://ehs.unl.edu/sop/s-injury.pdf.
Download the form