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Reporting Work-Related Injuries
Employees who
experience any work-related accident, injury, illness or exposure must
report the incident and submit a completed Occupational Accident Report
Form (SU-17).
Immediately report
the incident to:
·
Your supervisor
·
SLAC Medical Department, A&E Building (Building 41), Room
137
If the SLAC Medical Department is closed, notify the Department by phone
at Ext. 2281 or e-mail to mggherman@SLAC.Stanford.edu as soon as
possible. Leave a message noting:
o
Your name
o
Nature of the injury
o
Time and date of the occurrence
o
Name of clinic or hospital where you received treatment
Within 24 hours of any occurrence, you
must:
·
Obtain, complete, sign, and submit Side A of the
Employee’s Statement of an Occupational Accident Report (SU-17).
Forms are available at the SLAC Medical
Department. The SU-17 fulfills legal requirements, permits determination
of the level of investigation required to generate subsequent reports
and suggests possible remediation. You must complete an SU-17
even if you do not seek medical treatment.
Supervisors must promptly complete and
sign Side B (Supervisor’s Statement) of the SU-17 and return the form to
the SLAC Workers’ Compensation Administrator, MS 11.
Supervisors who do not receive an SU-17
within a few days of a reported injury, must obtain an SU-17 from the
SLAC Medical Department, complete Side B, and return the form to the
SLAC Workers’ Compensation Administrator, MS 11.
Contact: Sharon
Haynes, Workers’ Compensation Administrator, Human Resources Department,
Ext. 4533, shaynes@slac.stanford.edu |
