Workers Compensation

IF EMERGENCY MEDICAL TREATMENT IS REQUIRED, PLEASE IMMEDIATELY CALL 911 OR GO DIRECTLY TO THE EMERGENCY ROOM.

INSTRUCTIONS:

Supervisor:

1. Employee Incident Report– with notification of an illness or incident, it is the responsibility of the supervisor to complete and immediately submit the form to HR Benefits and Compensation.
   1. Form is located on the tsc.edu website/Human Resources/Forms/Workers Compensation/Employee Incident Report.
   2. Must be completed within 24 hours of illness or injury.
   3. Form should be emailed directly to This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; or hand delivered to Human Resources located in Tandy 105.
2. Witness Statement – it is also the responsibility of the supervisor to complete witness statement and forward to HR with the Employee Incident Report.
   1. Form is located on the tsc.edu website/Human Resources/Forms/Workers Compensation/Witness Statement.
   2. Must be completed within 24 hours of illness or injury.
   3. Form should be emailed directly to This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; or hand delivered to Human Resources located in Tandy 105.

Employee:

1. Report illness or injury immediately to Supervisor.
2. If illness or injury is an emergency, Call 911 or Go Directly to the Emergency Room.
3. Report to Human Resources for the following paperwork to take to the clinic:
   1. Verification of Employment;
   2. Verification of Coverage;
   3. Employee Rights and Responsibilities;
   4. Acknowledgement of Medical Alliance (Medical Network);
   5. First Fill Program/ Medication Card (English/Spanish);
   6. Form to elect leave benefits.
4. Take paperwork to Alliance Network Facility.
5. Deliver Texas Workers Compensation Status Report to Human Resources.
6. Obtain Authority to Report to Work and deliver to Supervisor.