General Information

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Employee's Responsibility:

• Complete and submit Report of Injury form to NNWCP
• Report injury to supervisor and/or colleague
• Seek medical attention, if needed
• Submit doctor's statement to NNWCP and employer
• Update NNWCP on follow up appointments

Supervisor's Responsibility:

• Check on injured worker, recommend for medical attention
• Make initial inquiries and investigation
• Provide supervisor statement to NNWCP
• If injured worker is incapacitated, complete and submit Report of Injury form to NNWCP
• Submit supporting documentation

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Required Documents/Forms include but are not limited to the following:

• Employment Verification (document should include Effective Date, Employer Name, Title, Hourly Rate)
• Accident or Police Report
• Photographs of accident area and injury
• Witness statement
• Job description
• Shift, Weekly, or Monthly schedules
• Official Timesheets
• Doctor/Work statement
• Travel Authorization
• Meeting Agenda and Sign In Sheets
• Vehicle Mileage Log
• Medical consent forms
• Medical referral notices
• Travel Expense Reports

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