you are at: Home Financial Operations Workers Compensation Injury Reporting

State Employee Workers' Compensation and Injury Prevention (WCP) -- Injury Reporting

What do you do if you have been injured on the job?

  • Call 911 in a serious medical emergency
  • Report your injury to your supervisor immediately
  • You, your supervisor, or your HR Representative must complete a Vermont State Employee's Workers' Compensation Incident Report online as soon as possible, but no later than 72 hours following the injury.  Please be sure that only one report is created on line to avoid duplicate claims.
  • Call your Workplace  Safety Coordinator to discuss any safety concerns
 
Office of State Employee Workers' Compensation and Injury Prevention (WCP)
Instructions for Electronic Incident and Injury Reporting

 

WHO SHOULD REPORT THE INJURY?  An injury may be reported by an injured employee, the employee’s supervisor or Human Resources Administrator.  It is the duty of the supervisor to insure that a report was made within the required 72 hours.  Please be sure that only one report is created on line to avoid duplicate claims.      

 

WHEN SHOULD AN INJURY BE REPORTED?  Any work-related incident should be reported immediately whenever possible.  The incident should always be reported within 72 hours of the employer’s knowledge of the injury. 

 

HOW DO I REPORT AN INJURY?  State Employee work-related injuries should now be reported on-line through the Vermont State Employee’s Workers’ Compensation Incident Report.  This form can only be completed by and for an individual who is a current State of Vermont employee with a valid State Employee ID number.  If the injured employee does not have a State Employee ID number, please call WCP at (802) 828-2899.  You, your supervisor, or your department HR Representative must complete a Vermont State Employee's Workers' Compensation Incident Report online as soon as possible, but no later than 72 hours following the injury.  YOU MUST USE MICROSOFT INTERNET EXPLORER WHEN COMPLETING THIS FORM.  THIS FORM IS NOT SUPPORTED BY MODZILLA FIREFOX.

 

IS THE VT DEPT OF LABOR (VDOL) FIRST REPORT OF INJURY (FORM 1) STILL REQUIRED?  You do not need to complete a VDOL First Report of Injury (Form 1)?  WCP will report the injury to VDOL electronically if the injury requires medical attention or results in lost time from work. 

 

WHO WILL RECEIVE A COPY OF THE INJURY REPORT?  The injured worker and the Department Human Resources Administrator will receive a copy of the WC Incident Report by mail.  If the injury requires medical attention or if the injured employee loses time from work, a copy of the VDOL First Report of Injury (Form 1) will also be provided.  

 

HOW DO I REPORT MORE THAN ONE INCIDENT OR INJURY:  If you are reporting multiple incidents, you should complete, submit, and print the Vermont State Employee’s Workers’ Compensation Incident Report for one employee before initiating another report.  To begin reporting the next incident you must use the “Reset” button located at the top left corner of the page.  All information will need to be re-keyed.  You cannot just overwrite previous information for a new incident as the old information will be retained and added to the next report.

 

INSTRUCTIONS:  Please complete all fields. 

 

Tool Tips: Tips for answering certain questions may be found by “hovering” over the field with your cursor.
   
Reporter: Enter the 5-digit Employee ID Number and first four letters of the Last Name for the person completing the form and press the Tab button.  The rest of the information for the reporter will automatically fill in and the remainder of the form will display.
   
Employee: Enter the 5-digit Employee ID Number and first four letters of the Last Name of the injured worker and press the Tab button.  Answer the remaining questions in this section as appropriate.  NOTE:  If the employee has more than one job with the State, they will need to select the job that they were working when they were injured.
   
Employer: Use the “Drop-down box” to select the Division which best describes where the injured worker is employed.
   
Incident: Use the “Drop-down box” to select the Nature of Injury and Body Part(s) Injured.   You may add up to three additional injured Body Parts by using the “Add Body Part” button.
   
Submit: When you have completed the form, please review your answers for accuracy and then hit the “Submit” button located at the top left corner of the page.  This will then activate the “Print” button also located at the top left corner of the page.  You should print a copy of this form and retain it for your records.

 

Be sure to record the Claim Number (begins with WC) for future reference.  Those injuries for which treatment is not expected (Incident Only) will not generate a WC Claim Number.

 

Any comments or suggestions regarding this web page or the injury reporting process should be forwarded to riskhelp@state.vt.us or can be provided by calling (802) 828-2899.