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Accident/Injury Report Form

Employees, students and visitors to Western Â鶹´«Ã½Ó¦Óà University may access this form via (311 form) which includes a link to the form and related instructions. The the Accident Injury Report (311 form) must be completed for all work-related injuries, no matter how serious.

Physical Capabilities Form

Please use the Accident / Injury / Incident Report (311 Form) to report all incidents, injuries and illnesses.

Report of Claimed Occupational Injury or Illness

Print form and have injured employee bring to Sindecuse Heath Center with the Physical Capabilities form (see above).

• Report of claimed occupational injury or illness
• Report of claimed occupational injury or illness

Workers Compensation Sick Leave Designation Form (AFSCME)

For use by AFSCME employees. Please complete the sick leave designation form to utilize accumulated sick leave to supplement workers' compensation benefits.

• Sick leave designation form
• Sick leave designation form