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[Printable Instructions]

1. In the event of a medical emergency, please dial 911.

2. Immediately notify your supervisor.

3. Notify the Office of Human Resources of your injury by completing the Employee Injury/Illness Incident Report with your supervisor on the same day as the injury, if possible.

   • Include as much detail as possible regarding the injury. [i.e., location (campus, street, building, floor); injured body part; description of how injury occurred]

   • The report must be completed even if the injury is considered minor, if no medical attention was needed, or if time was not lost from work.

   • When the form is completed and signed by you and your supervisor, send it to the Office of Human Resources by email (ashively@iup.edu) or fax (724-357-2685).

4. Seek non-emergency medical treatment within the first 90 days from a physician listed on the Â鶹ÊÓƵ Panel of Physicians.

   • Email, fax, or mail any related documentation received from the medical provider as soon as possible following treatment to the Office of Human Resources.

5. If medical attention was sought and/or time was lost from work due to the injury, the Office of Human Resources will file a claim with Inservco Insurance Services, our third-party workers’ compensation insurance company.

   • If a claim is filed, Inservco will review the claim information and determine if it is compensable under the Workers’ Compensation law

   • Inservco will notify you directly whether or not the claim is approved.

6. Review your rights and responsibilities under the Pennsylvania Workers’ Compensation Law on the Workers’ Compensation Employee Notice and the WC Information Sheet for your employee group below:

   • Workers’ Compensation Employee Notice of Rights and Duties

   • Workers’ Compensation Information Sheet for AFSCME / PSSU / SPFPA

   • Workers’ Compensation Information Sheet for APSCUF/Coaches/Managers/OPEIU/SCUPA

• Employee Workplace Injury/Illness Incident Report
• Workers’ Compensation Employee Notice of Rights and Duties
• Â鶹ÊÓƵ Panel of Physicians
• Workers’ Compensation Information Sheet for AFSCME/SEIU/SPFPA
• Workers’ Compensation Information Sheet for APSCUF/Coaches/Managers/OPEIU/SCUPA
• Workers’ Compensation Temporary Prescription Benefit Card