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Work-Related Incident/Injury Information

WORK-RELATED INCIDENT/INJURY PROCEDURE

 

PURPOSE:
  1. To identify and help prevent employee incidents and injuries.
  2. To facilitate the processing of Workers’ Compensation benefits.
  3. To ensure thorough reporting and investigation of employee incidents and injuries.
  4. To help the District facilitate employee’s recovery from work-related injuries.
APPLICABLE TO:

All employees

RESPONSIBILITY:

See Procedures 

POLICY:

The Board of Education directs that all reasonable efforts be made to ensure a safe learning and working environment for the pupils and employees of this district.  To that end and to the end that legitimate employee claims for worker’s compensation be expedited, the Board requires that accidents be reported and evaluated.  Any accident that results in an injury, however slight, to a pupil, an employee of the Board, or a visitor to the schools must be reported promptly and in writing to the district business office.  Injured persons shall be referred immediately to the school nurse for such medical attention as may be appropriate.

 

The injured employee or visitor or the staff member responsible for an injured pupil shall complete a form, available in the office of the Building Principal, that includes the date, time and place of the incident; the names of persons involved; the nature of the injury, to the extent that it is known; and a description of all relevant circumstances.

 

A copy shall be retained by the Building Principal and a copy shall be sent to the business office.

 

Any employee of the Board who suffers a job-related injury must report the injury and its circumstances to the Building Principal or job supervisor, as appropriate, no later than twenty-four hours following the occurrence of the injury.  The failure of an employee to comply with this mandate may result in disciplinary action.

 

Employees will be provided a safe and healthy work environment.  Employees who are injured on the job will receive assessment and treatment, if appropriate, in order to ensure recovery and a prompt return to work.  Workers’ Compensation benefits will be provided in accordance with New Jersey Law.  This will be accomplished by:

  1. Affirmative efforts of the district to prevent employee injuries.
  2. Prompt diagnosis and treatment of work-related illnesses and injuries.
  3. Timely submission and analysis of accident/incident reports.
  4. Injured employees will in most instances report to the designated health care facility for the initial evaluation.
  5. Employees may elect to receive treatment from the physician of their choice. Incident/Injury Report Form immediately following the incident.  All injuries, no matter how minor, must be reported. The employee is responsible for initiating the process and must notify his/her immediate supervisor of the incident.  The supervisor and the department manager are responsible for completing and monitoring the incident reporting process.
PROCEDURE: & RESPONSIBILITY:

 

Employee Responsibility:

  1. Employee reports incident to School Nurse and/or Building Principal, and completes, with the School Nurse's assistance, the Employee Report section of the Incident/Injury Report Form. When form is completed and signed, the employee gives it to the Principal or Designee for completion.
  2. If treatment is needed, or an examination is desired by the employee, employee shall call NJSIG at (609) 543-3377*. If applicable the employee reports to the designated treatment facility as recommended by NJSIG (see Combined Business Card). In case of an emergency, go to the nearest hospital and then employee shall be responsible to contact employer and NJSIG within 24 hours. At this time, DO NOT go to your own medical provider.

    *Call 609-543-3377

    The nurse/supervisor and/or injured employee may call our Intake line directly to speak with an NJSIG intake representative. Representatives are available during standard business hours (M-F, 8AM-5PM). We have English and Spanish representatives available. Once the report is taken, the injured employee will be directed to treatment. The DDI will be sent to the treating doctor’s office by the NJSIG intake representative.

    We encourage the injured employee to leave a voicemail if an intake representative is not available. The call will be returned within the same business day.

    After standard business hours: The injured employee should leave a voicemail about their injury and will be contacted within one business day by an intake representative.

  3. Employee presents a photocopy of the incident form and any other NJSIG forms that may be necessary* to designated treatment facility, provided by the School Nurse or Designee.

*(Business Card Combined, DDI Letter (if not provided by NJSIG), Mitchell Flyer, and/or Medical-Authorization Form, if applicable) 

School Nurse Responsibility:

  1. Assists* injured employee in completing the employee section Incident/Injury Report Form details and/or assists injured employee in calling and speaking with a NJSIG intake representative.  Ensures all information in Employee Report section is provided, and indicates whether employee had lost time from work.

    *Call 609-543-3377

    The nurse/supervisor and/or injured employee may call our Intake line directly to speak with an NJSIG intake representative. Representatives are available during standard business hours (M-F, 8AM-5PM). We have English and Spanish representatives available. Once the report is taken, the injured employee will be directed to treatment. The DDI will be sent to the treating doctor’s office by the NJSIG intake representative.

    We encourage the injured employee to leave a voicemail if an intake representative is not available. The call will be returned within the same business day.

    After standard business hours: The injured employee should leave a voicemail about their injury and will be contacted within one business day by an intake representative.

  2. The Department of Labor and Training requires that a copy of the report be received in their office within 24 hours of an incident.  Therefore, the School Nurse or Designee must send completed Incident/Injury Report to the Office of Human Resource Coordinator promptly. (The main office staff may be asked to scan and email reports to the HR Coordinator at times)
  3. If injury requires an examination, or if employee desires an examination, send employee to the treatment facility that is designated by NJSIG with a photocopy of the completed Incident/Injury Report form, a DDI letter, and a Mitchell Script Advisor. The original copies are sent to the Office of Human Resource (R. Barth).
  4. If no examination is to be done, forwards completed Incident/Injury Report form to the Office of Human Resource (Ralph W Barth), before the end of the school day on which the incident was reported. (The main office staff may be asked to scan and email reports to the HR Coordinator at times)
  5. If an employee has suffered a serious injury, 911 should be called and he/she should be taken directly to the nearest emergency health care facility or Hospital.  All paperwork should be completed as soon as possible thereafter.
  6. If treatment is needed, or an examination is desired by the employee, employee shall call NJSIG at (609) 543-3377 and if necessary, assisted by the school nurse. If applicable the employee reports to the designated treatment facility as recommended by NJSIG (see employee responsibility section “b”).

Workers' Compensation Accident Reporting Guidelines:

NJSIG's Workers' Compensation Intake Reporting: 609.543.3377

Business Hours: Monday — Friday | 8:00 AM — 5:00 PM

All calls are returned within the same business day. If calling after hours, calls are returned within one business day.

Download the Three Ways to Report a Claim flyer: English  | Spanish 

Three Ways to Report a Claim:

  1. Call 609-543-3377 to speak to NJSIG's intake team. The injured employee will be directed to treatment. English and Spanish team members available.
    1. If calling after standard business hours, please leave a message about your injury and you will be contacted within one business day.
  2. Click here to complete online First Report of Injury (FROI) 
  3. Download FROI: Click here for English  | Click here for Spanish  | Click here for Polish  | Click here for Portuguese 
    1. Please email fully completed FROI forms to [email protected] or fax to 609-386-2188.

If you indicated a need for treatment on the FROI form, you will be contacted by a workers' compensation specialist within one business day.


In case of emergency or after standard business hours:

  • The employee should report directly to an emergency room or nearest urgent care for treatment.
  • Upon discharge, or when the employee's condition is stable, the employee must call NJSIG to report the injury.