Work Injury
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Notify Supervisor and Program Nurse of injury immediately.
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Fill out the Employee Report of Injury and HIPPA form found below.
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If you wish to seek medical attention, inform your Supervisor or Program Nurse. They will contact Ausra Petry in the Business Office. An authorization for treatment will be sent to Physicians Immediate Care (PCI) prior to your arrival, if that is your provider of choice.
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Submit all completed paperwork to your Supervisor or Program Nurse (per Supervisor direction). DO NOT TURN THESE FORMS INTO PCI.
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Follow up with your Supervisor regarding injury treatment and ability to return to work.
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The supervisor will complete a Supervisor Report and ask for Witness Statements, if witnesses are indicated on the employee's injury report.
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The supervisor or Program Nurse (per Supervisor's direction) will submit all paperwork to the Business Office for processing.
If you have any questions or concerns regarding Worker's Compensation, please contact Crystal Luna at 708-342-5327 or cluna@swcccase.org.
Work Injury Documents
Employee must complete this form, including initials, to grant permission for work injury paperwork submission.
Employee is not responsible for completing this form. Supervisor will submit to business office.
Please fill out at time of incident.
If a witness is indicated on injury report, this form should be completed.