Employee Injury

If an employee is injured on the job or have a job- related illness, the following guidelines must be followed.

  1. The employee will complete the Employee’s Report of Injury Form.
  2. The employee will tell the supervisor about the injury or illness (MUST be done by the end of the shift).
  3. The employee will go to Employee Health and Wellness for care.
  4. The employee will go to the Southeast Health Emergency Department if the injury is urgent/life threatening or if Employee Health and Wellness is NOT open.

NOTE: If the employee goes to the Southeast Health Emergency Department, they should call Employee Health and Wellness as soon as they are open to report the injury or illness.

  1. The employee will give the supervisor the Employee’s Report of Injury Form after it has been filled out.
  2. The supervisor will investigate the accident. The supervisor will complete their portion of the Employee’s Report of Injury Form.
  3. The employee must submit the completed Employee’s Report of Injury Form to Employee Health and Wellness within 24 hours of the injury.
  4. The employee will receive a detailed written statement (Work Status Form). This form will explain any work restrictions and/or modifications. It is the responsibility of the EMPLOYEE to tell the supervisor about any work restrictions and/or modifications.
  5. Employees should NOT go to their personal health care provider.
  6. Those who do not follow these instructions may lose the benefits for Workers’ Compensation.

Employee’s Report of Injury Form:

Work Status Form (May only be located in EH&W/Southeast Health Emergency Dept.):

  • To be completed by health care provider
  • To be signed by employee and supervisor
  • Copies to employee, supervisor and EH&W

Airborne Pathogen Exposure

  • For confirmed cases of TB that were not identified on admission therefore not placed on airborne isolation, Infection Prevention will notify all areas that had contact with the patient and the Director of those areas will inform the exposed employees and complete the TB exposure Jotform, located on the inside SEH page.
  • This page is accessed under the Employee Resources tab-Employee injury and exposure tab.
  • Exposed employees will report to Employee Health and Wellness. Employee Health and Wellness will collect an initial Quantiferon Gold and place the employee on the schedule to return in 8 weeks for a second test.
  • If you are a credentialed but non-employed provider or staff member, you will need to be added to the JotForm by the Director of the department in which you were exposed. You may receive treatment at GME.
  • For data reporting and tracking purposes, Infection Prevention has an Epic report that shows the number of exposed employees and the number that converted after exposure (for annual regulatory purposes), and Employee Health and Wellness will have access to all exposed employees per the jot form as well as Employee Health and Wellness.

Needlestick Procedure

  • The Bloodborne pathogen exposure packet and report of injury should be printed and completed. Orders for testing of source patient as well as the exposed employee should be obtained and sent to lab.
  • Employee will report to Employee Health and Wellness during regular business hours or to Laboratory Medicine at all other times with the completed exposure packet.
  • Laboratory Medicine will draw appropriate labs on employee and report results to Employee Health and Wellness.
  • If the employee chooses treatment with prophylactic medication, they will be referred to Southeast Health Medical Center Clinic or other designated clinic by employee health for medical evaluation and treatment.

Form PDFs: