Procedures for Reporting a Work-Related Injury:

Workers’ Compensation Procedure

Once an employee has been injured on the job, the following steps must be taken:

• Employee must immediately inform their supervisor about the injury and report to the nearest nurse. • The nurse will check on the employee’s welfare and determine the severity of the injury. The nurse will provide you with an incident packet. • If medical treatment is necessary, the employee will be sent to one of the providers listed: YISD Wellness Health Clinic Dr. Manoucherhr Refaeian 9600 Sims Dr. Eastside Rehabilitation and Pain Clinic (915) 434-0484 10412 Vista Del Sol, Suite 1-B (915) 593-9300

Dr. Carlos M. Remirez RE Medical Associates 6024 Aztec Rd. (915) 594-7787

Dr. Michael J. Mrochek The El Paso Orthopaedic Surgery Group 3100 Lee Trevino & 9999 Kenworthy, Ste. C (915) 533-7465

• YISD Risk Management Department is notified via a completed incident report. • In case of an emergency or an afterhours injury requiring medical attention, the employee will notify the supervisor and Ernie Landeros at (915) 540-9804, and then proceed to the emergency room. If immediate treatment is not necessary, the injury must be reported the following morning to the nearest nurse.

Procedures to follow when returning to work from a work- related injury:
Note: These procedures only apply when an employee has been injured on the job AND has received the services of a physician.
● If you are losing time from work, please notify the Risk Management Department immediately. • Obtain DWC-73 Form (Release to regular or modified duty) from treating physician or have physician submit the form to the YISD Risk Management Department. • If physician releases the employee back to work with restrictions or completely removes him/her from work, the employee cannot report back to his or her worksite without first reporting to the YISD Risk Management Office to get clearance. (During holidays, weekends, or after office hours contact Claims Administrative Services (CAS) at (915) 591-4181. • Employee must be approved to return to work by the Risk Management Office (If employee cannot be accommodated with restrictions, injured worker will not be allowed to report to work.) • If approved, employee reports to work site. The Risk Management Offices are located at: YISD Central Offices, 9600 Sims (2nd floor)
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9999 Kenworthy, Ste. C 533-7465

Take Gateway North Exit Transmountain Rd Turn Right on Transmountain Rd

Turn Right on Kenworthy

INSTRUCTIONS FOR COMPLETION
OF THE
WORKERS’ COMPENSATION – INCIDENT REPORT

The Employee and Supervisor Incident Report must be completed in full by the employee and their immediate supervisor within 24 hours of the incident and submitted to Risk Management via Fax Number 915-435-9584.

FAILURE TO SUBMIT A COMPLETED REPORT WITHIN THE REQUIRED TIME MAY DELAY THE PROCESSING OF YOUR REQUEST FOR WORKER’S COMPENSATION BENEFITS OR MAY RESULT IN A DENIAL OF YOUR CLAIM FOR BENEFITS IN PART OR WHOLE.

If you have any question, please contact Risk Management at 434-0460.

EMPLOYEE 1. The employee should complete the entire report their own handwriting. 2. The employee is to complete the entire report, (boxes 1-42) including the two boxes above box 1. 3. DO NOT FORGET TO FILL IN YOUR SOCIAL SECURITY NUMBER and the date of the report. 4. Box 33: List all the body parts that were injured with a description to indicate the side of the body. (i.e., right knee or left shoulder). Use another page if necessary, but remember to fax all additional pages. 5. Box 34: Read the contents of this box and place your initials