Workers Compensation Forms/Procedures

Norfolk Public Schools strives to ensure a safe working environment for all employees.  However, occasionally work related injuries do occur.  If you are injured while at work, please follow the directions below. All necessary forms are available on this page.

Accident Reporting Procedures/Forms (Printable)

Accident Reporting Procedures

  1. Report the injury to your supervisor immediately.
  2. Complete forms, as listed below.
  3. Return forms to HR or your building principal.
  4. If medical attention is necessary, follow steps on the Claim Access Form.
  5. Provide HR with a copy of all Return to Work notes, after each doctor's appointment.
  6. Follow any doctor's orders and restrictions at home and at work.

Accident Reporting Forms (All forms are required and must be submitted to HR)

  1. Employee completes and submits a Workers Compensation Incident Report Form within one hour.
  2. Employee completes and submits a Doctor Choice-Form 50 within one hour.
  3. If medical attention is necessary, give the medical provider the Claim Access Form.
  4. Principal completes and submits an Accident Investigation Report.
  5. HR staff complete and submit a First Report of Alleged Occupational Injury of Illness Form.

Please Note:

    • It is the responsibility of the employee to maintain consistent communication throughout their treatment process with Norfolk Public Schools when receiving workers’ compensation benefits.
    •  It is the responsibility of the employee to adhere to any work restrictions that may be given by their treating physician.
    •  It is the workers’ compensation company, not Norfolk Public Schools that determines payment of workers’ compensation claims.