1 / 15

This form can be found on

What to do if you are injured at work and need medical attention click on left side of mouse button to go to next slide.

jane
Télécharger la présentation

This form can be found on

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. What to do if you are injured at work and need medical attentionclick on left side of mouse button to go to next slide

  2. Employee Report of InjuryAfter notifying your supervisor and contacting Risk Management at 436-1760 or 436-1767complete this form. Send to RM within 48 hours of your injury. If the injury report is not received in our office within 72 hours of your injury you will be required to come into Risk Management and complete the form.click on lps.org to take you to the website to get this form. The form number is in the top left hand corner.Single click on left side of mouse to go to next slide This form can be found on

  3. Nebraska workers’ compensation law states you have the right to choose a physician who has a record of treating you or an immediate family member prior to your injury. If you do not have a record of treatment with a physician or your physician does not take workers’ compensation you will then need to be evaluated at one of the district’s designated treatment facilities. Single click on left side of mouse to go to next slide

  4. Employee Choice or Change of Doctor FormThis form should be completed prior to seeking medical treatment. Be sure to complete Part A and Part B and turn in with your Employee Report of Injury. Click on lps.org to take you to the website to get this form. The form number is in the top left cornerSingle click on left side of mouse to go to next slide

  5. Release to Return to WorkEach time an employee is evaluated by a physician for a work injury they will need a new release. Custodians should take the release to CTS first and CTS will send the release to Risk Management. All other employees should bring or fax the release to Risk Management. It is your responsibility to make sure Risk Management receives a copy.You will not be allowed to return to work without a release.As tolerated is not accepted on a releaseEmployee should sign release stating they are aware that their restrictions apply at work and at home.Click on lps.org to take you to the website to get form RM0005. The form number is in the top left cornerSingle click on left side of mouse to go to next slide

  6. When you report your injury to Risk Management and are not going to your physician, you will be given the phone number for Madonna Fit for Work so you can call and an appointment time will be scheduled at one of these facilities. If it is during regular business hours do not contact these facilities to make your own appointment.Single click on left side of mouse to go to next slide

  7. After Hours CareUrgent Care at Life Pointe 7501 S. 27th St.M-F 8 a.m. – 8 p.m.Sat. & Sun. 9 a.m. to 5 p.m. 481-6343Heartland Urgent Care 965 South 27th Street, Suite DM-Sat. 8 a.m. – 8 p.m.Sun. 10 a.m. – 6 p.m. 477-3505Fallbrook Family Health Center 755 Fallbrook Blvd., Suite 100M-Th 7 a.m.- 7 p.m. Fri. 7 a.m.- 5 p.m.Sat. 9 a.m. to noon 441-3575 Single click on left side of mouse to go to next slide If you have an injury after hours notify your supervisor of your injury. You may go to one of these facilities for treatment or an emergency room if the injury warrants treatment there.

  8. Please review the HR#2 it provides information on workers’ compensation and what is expected from you and what you can expect when filing a claim.Single click on left side of mouse to go to next slide

  9. Single click on left side of mouse to go to next slide

  10. Single click on left side of mouse to go to next slide

  11. How to access all Risk Management Forms

  12. Go to the lps.org webpage and type the word “forms” in the keyword boxclick on left side of mouse to move through slides

  13. In the drop down box find Risk Management, hit enter

  14. On the website click on the form you want and print.

  15. If you have any questions regarding this process please contact Risk Management at 436-1760 or 436-1767

More Related