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Workers’ Compensation

Even in a workplace with relatively few hazards, there is always a possibility for an employee or student worker to become injured at work. If an injury occurs at work, please follow the steps below.

If a work-related death occurs, contact the Risk and Safety Department ( and Human Resources (920.424.1166) immediately.

IMPORTANT:  Adobe (PDF) documents need to be saved/downloaded to your hard drive and opened from your desktop BEFORE you complete the form. The PDF will only save as blank from your browser.  If you complete the form in your browser, you will lose the information you completed and it will only be saved as a blank form.

Step 1

  • The employee must complete the Injury and Illness report and submit it to their supervisor. It is the employee’s responsibility to report the injury to their supervisor promptly after the injury has occurred.
    • Detailed information related to workers’ compensation can be found here.
  • The employee’s supervisor must complete the Supervisor’s Accident Analysis and Prevention reportIt is the supervisor’s responsibility to ensure that the employee’s First Injury and Illness report and the Supervisor’s report are submitted to BOTH and emails as soon as possible after an injury occurs.
    • For an overview of the supervisor’s responsibilities in the workers’ compensation process, click here.

Step 2

  • The acceptance or denial of a workers’ compensation claim is determined by the UW System Workers’ Compensation Coordinator in the Risk Management division of UW System Admin. The Workers’ Comp Coordinator will contact the injured employee with questions about the incident and provide details of the claims process.
  • If the injured employee or supervisor has any questions or concerns regarding the claims process, they should contact the campus EHS Manager, Lori Welch (, or via email at

Step 3

  • Time card/leave reporting should indicate any lost time due to a work-related injury. If lost time occurs, the time card/leave report must indicate those days off of work. Human Resources Payroll personnel may assist with how time should be recorded on the time card/leave report on a case-by-case basis.
  • The Environmental Health and Safety (EHS) Manager will review all injury reports and interview relevant parties to assess work practices, environmental conditions, equipment use, etc.,  Recommendations for improvement will be made as needed.

Additional Resources

Click here to access the Witness Statement form.

Supervisors: click here for tips on managing an employee who is returning to work.

For further information regarding Workers’ Compensation, please visit the UW System Workers’ Compensation website.