Accident Form Instructions
- Immediately report any injury to your supervisor, even if the injury seems minor. (You may lose your rights if not reported promptly.)
- Fill out the workers compensation accident form and return it to the Human Resource office by the end of the shift or within 24 hours of accident.
- If the injury occurs on a weekend, please submit the accident form to the HR office by Monday morning.
- If medical treatment is necessary, inform the physician or hospital that it is a work related injury. This helps insure that your visit is properly billed and not delayed. An excuse from work or a release back to work notice is required.
Kelli Stevens, HR Assistant Craig Blake HR Director
Phone: 435-893-0409 Phone: 435-893-0459
Cell: 435-201-1726 Cell: 435-979-6580
Fax: 435-893-0495 Fax: 435-893-0495
* Supervisors must contact the Human Resource Department immediately if a claim appears to be suspicious or questionable or if the accident resulted in a fatality.FORMS:
Worker's Compensation Claim Form -Sevier County Accident Report
Utah Counties Insurance Pool (UCIP)