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Risk Management and Safety

Workers Compensation (Employee) Injury Reports

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What is a reportable incident?

An incident is an unplanned accident, occurrence, or event. An incident that may result in a financial loss to BYU needs to be reported to the Risk Management Department within 24 hours, if feasible, or as soon as possible via the incident.byu.edu website. The following are examples of a possible financial loss that needs to be reported:

  • An injury to a BYU employee, BYU student, guest, or visitor on Campus,
  • Accidental damage to University owned property including vehicles, buildings, structures, and business equipment,
  • An injury to participants in any campus sponsored events, i.e., EFY, FSY, Sports Camps, Conferences, etc.

What should I do immediately after an employee is injured while working?

  • Depending upon the severity of the injury, minor First Aid treatment may be rendered or the employee may visit the Student Health Center for medical assistance.
  • If EMTs or Police Officers have responded to the injury and have cleared the scene, do not disturb the scene immediately surrounding the incident until photos or video has been obtained.
  • Collect the names and contact information of any witnesses or involved parties.
  • Retain items related to the origin and cause of the loss, if practical, in a secure location.
  • Visit the incident.byu.edu website, click on the Employee Injury icon and with the injured employee’s help complete a Supervisor’s Report of Workers’ Compensation Injury report form.
  • Within two weeks of reporting the employee injury, please complete the developed corrective actions and mark them as completed in the Uncompleted Actions page.

What information is needed for the injured employee report form?

  • Name of injured person,
  • If injured person is a minor, please include name of Parent/Guardian and contact information.
  • BYU Net ID or BYU ID number,
  • Date of birth and age of injured person,
  • Marital Status,
  • Gender,
  • Number of Minor dependents,
  • Email address,
  • Current address,
  • Preferred phone number,
  • Job Title,
  • Job Status,
  • Job Type (Full-time, Part-time, Student, etc.),
  • Date Hired,
  • Department,
  • Name of Supervisor,
  • Supervisor’s phone number,
  • Supervisor’s BYU ID number,
  • Supervisor’s email address,
  • Health Insurance Company
  • Personal Physician,
  • Date and time of injury (AM/PM),
  • Day of the Week,
  • Hour Shift Began (AM/PM),
  • Time injury reported to Supervisor (AM/PM),
  • Date injury reported to Supervisor (mm/dd/yyyy)
  • Injury type (laceration, strain/sprain, fracture, etc.),
  • Body part (left big toe, right wrist, left ear, etc.),
  • Cause (lifting, repetitive motion, slip and fall, trip, bending, etc.),
  • Will the individual miss work beyond the date of injury? (Yes/No),
  • Number of hours individual works per day,
  • Number of days individual works per week,
  • Location of incident (street address, description of building, area, parking lot, etc.),
  • Description of how injury occurred. Please provide as much detail as possible.
  • Description and location of immediate treatment of injury (on-site First Aid, SHC, none, etc.),
  • Attending Physician’s name,
  • Witness name and phone numbers (cellular, home/work),
  • Authorities contacted (i.e., BYU PD, Fire Dept., EMTs, etc.), and
  • Name and phone number of person completing form.

What happens after the employee injury is reported on the incident.byu.edu website?

  • An incident report is generated and submitted to the BYU Risk Management and Safety’s (BYU RM&S) Incident Office. Upon receipt, the incident is submitted by RM&S’s incident office to The Church of Jesus Christ of Latter-day Saint’s Risk Management Department (CRMD) and a worker’s compensation claim is generated through the Global Incident Reporting (GIR) system.
  • Once the claim has been received by CRMD, the workers compensation claim will be handled by CRMD Risk Manager or it may be assigned for adjusting to Sedgwick Claims Management Services, Inc. (SCMS), a contracted third-party claims administration (TPA) corporation.
  • The injured employee will receive an email from RM&S’s incident office with instructions about who they can contact and the worker’s compensation claim number.
  • If the worker’s compensation claim has been assigned to an adjuster with SCMS, the adjuster will contact the injured employee within 24 hours of receiving the claim.

For more information, please contact BYU's Risk Management & Safety Department

Incident Management Office

Telephone: 801-422-5150
Email: incident_mgmt@byu.edu

Claims Manager:

Telephone: 801-422-1203

Risk Management Director

Telephone: 801-422-5779