OREGON STATE UNIVERSITY

Workers' Compensation - Forms

 

  • HR Advocate Public Incident Reporting Form
    • To be completed to document all OSU (employee and non-employee) accidents injuries and work-related illnesses. Should be completed for all OSU sponsored activities, and for incidents occurring at OSU owned or leased property. This form is to be completed by the manager/supervisor in cases of employee injury or work-related illness.
  • SAIF 801 Form
    • For employee injuries where medical attention is sought, the SAIF 801 form would be completed within 24 hours by the employee and supervisor (utilizing the manager/supervisor instructions for 801 below) and returned to Heidi Melton in Insurance and Risk Management Services. If the employee is unavailable to complete this form within 24 hours (for example, if they are hospitalized), the supervisor is responsible for completing as much of the while form as they can based on the information available and returning it to Heidi Melton in Insurance and Risk Management Services.
  • Manager/Supervisor Instructions for 801 Form
    • To be read by manager/supervisor before completing the “employer” portion of the SAIF 801 form. Please note that specific information is needed in the employer portion of the form, carefully read these instructions to verify what information goes in each field of the form prior to completion.
  • Employee Status Report Form
    • Specific medical release form to be taken by employee to each appointment with their Attending Physician in workers’ compensation claims. Attending Physician should complete this from at each appointment to verify the employees return-to-work status, expected duration of restrictions (if restricted) and if they are medically stationary, or if not, the date of their next appointment.
  • Timesheet Reporting for SAIF Claims with Time Loss
    • Specific timesheet instructions for employees who are not released to return to work (missing time authorized by their Attending Physician) – or – who are released to modified work for which modified work is not available to meet their average weekly wage.
  • Reporting Protected Leave on the Timesheet
    • Additional timesheet instructions and information for Family Medical Leave Act (FMLA) eligible employees who are missing time authorized by their Attending Physician.
  • Additional Supervisor Resources