Injury Report / Worker’s Comp

1. If you are able, fill out the Employee Injury Questionnaire. Each school office, nurse’s office, Human Resources office and the Superintendent’s Office will have the form available as well.
2. Submit your completed Employee Injury Questionnaire to the office in your building. This ensures that your principal/supervisor is made aware of your injury.
3. The Employee Injury Questionnaire MUST BE TURNED IN TO STACIE LAMPPA IN THE SUPERINTENDENT’S OFFICE OR TO DEBBIE WIIRRE IN HUMAN RESOURCES WITHIN 24 HOURS OF THE INJURY.
   Secretaries – Once an Employee Injury Questionnaire is turned in and the supervisor/principal has been notified, please scan/email it to Debbie Wiirre in Human Resources located at the Eveleth-Gilbert High School or to Stacie Lamppa in the Superintendent’s Office..
   Supervisors/Principals – If an Employee Injury Questionnaire has been turned in, you will need to complete the Supervisor’s Report of Injury.
4. If you have an injury that results in seeing a doctor, any work restrictions or notes related to your injury/lost time from the doctor must be turned in to Stacie Lamppa or Debbie Wiirre in a timely manner. Debbie Wiirre will submit this information to insurance, as well as the Employee Injury Questionnaire information. The Supervisor’s Report of Injury report must be completed for our records.

Please Note: If an injury results in an employee being unable to fill out the Employee Injury Questionnaire, someone who witnessed the injury could complete the form or Debbie Wiirre needs to be notified as soon as possible that an injury occurred.

Employee Injury Questionnaire Supervisor’s Report of Injury