Please use these forms if you should sustain a work related injury. Completion of these forms does not assure the allowance of the claim in accordance with the Ohio Bureau of Workers Compensation.
The injured worker should complete his or her portion of the accident report on the day the injury occurs. If this is not possible due to injury, the accident report should be completed as soon as the injured worker is able. Every box must be completed.
Once the injured workers' portion of the accident report is completed, the report should be provided to the supervisor. The supervisor should complete their portion of the report on the same day the report is received. Every box must be completed.
If the injured worker is not able to complete an accident report on the day of the incident, the supervisor will complete a report of injury form and forward as follows:
For physical facilities employees, SANDRA SMITH (330) 972-7313
For all other employees, MICHELLE SMITH (330) 972-7092
Any further information or documentation should be forwarded to the same.