Workers' Compensation

First Report of Injury Form

WORKERS' COMPENSATION SITE

St. Cloud State University is committed to fostering a safe and healthy environment for our faculty, staff, and students. If you experience a work-related injury or illness requiring immediate medical attention, please call 911 without delay.

If emergency medical care is necessary, an ambulance may be dispatched to assist you. Please note that, under Minnesota workers’ compensation insurance requirements, coworkers and supervisors may not transport injured employees for medical treatment. However, a family member or friend may provide transportation to a medical facility when appropriate.

All work-related injuries or illnesses must be reported within 24 hours to your supervisor or to Human Resources at 320-308-3203. The supervisor and the injured employee must then complete the First Report of Injury / Injury, Illness, Incident Data Form to ensure timely documentation and processing.

Supervisors: Send the completed forms to the Safety Administrator at safetyadmin@stcloudstate.edu.

If the injury is critical call 911.

If the injury is life threatening or fatal, Human Resources must also be notified immediately. 

The IDF (Incident/Injury/Illness Data Form) and other appropriate forms must be filed with the Human Resources office within 24 hours for receipt of notice of:

  • Any injury alleged to have risen out of and in the course of employment that incapacitates an employee from earning wages for 3 or more days.
  • Any injury that requires medical expenses to be paid.
  • Any job-related damage to eyeglasses or a prosthetic device.
  • The death of an employee as a result of a job related injury. If the employee dies at the work site, you must file an IDF regardless of the reason for death.

The employer & employee should retain a copy of the IDF. IDF forms are available in the supervisor or dean’s office, Human Resources office or download from Minnesota's Department of Administration. You may also need to complete additional forms, depending on the situation. Supervisors of the injured employee, along with the employee, must also review and complete the Supervisors checklist to ensure all appropriate forms are completed and the injured employee receives proper paperwork.

All forms can be found on the MN Department of Administration's website under Government Services > Risk Management > Workers' Compensation > Workers' Compensation Procedures.

The State of Minnesota, Workers’ Compensation Program uses a managed care organization, CorVel, to provide certified managed health care services. You may access care for a work-related injury or illness by going to a clinic or health care provider from CorVel’s network; or by accessing CorVel’s online Provider Lookup ; or by using Corvel's Information Line, which is available 365 days a year, by calling (612) 436-2542 or 800-275-8893. These services can refer you to the closest participating provider to your home or workplace to evaluate and treat your injury. 

Report any injury to your supervisor or designated person at work. If injured in the course of your work, you may receive treatment from a medical doctor, chiropractor, podiatrist, osteopath, or dentist, if the treatment is available within the community and is appropriate for the injury or illness.

You must receive all necessary medical treatment for your work injury from a health care provider who is a member of CorVel’s plan, except in the following circumstances: you have already established a treating relationship with a non-participating provider (who maintains your medical records)* prior to the work-related injury; or if you require emergency treatment; or if your place of employment and residence are beyond the mileage parameters set forth in part 5218.0100, subp. 1.F.(7). You may call CorVel’s information line at 612-436-2500 and notify them of your intent to seek treatment from a non- participating provider. Should you choose a non-participating provider, you must provide CorVel with documentation of your prior treating relationship within 10 calendar days of when you gave notice of your injury or illness to your supervisor or agency workers’ compensation coordinator.

For medical non-emergencies, CorVel provides a 24/7 work injury nurse line is available if needed by calling 1-844-235-2055. You will be connected with a registered nurse to give you the quality care you need. If it is an emergency, please dial 911.

If an employee receives treatment and has any type of work restrictions, this needs to be in writing from the treating physician and given to the employee's immediate supervisor with a copy sent to the Human Resources Office. We would then go through our ADA Accommodations Process. 

These same procedures apply to student worker/work study students whom are injured on the job.

Please remember that St. Cloud State employees need to work together in order to provide a safe and healthy work environment.

For additional information, go to the State Workers' Compensation website.

Ask human Resources