REVISED RCUH Forms for Workers Compensation Claims

To: All RCUH Principal Investigators and Supervisors

Effective today, the following workers compensation forms have been updated. Please use the below forms when submitting your employee’s Workers Compensation Claim.

Job Physical Analysis

Industrial Injury Report & Instructions for Completing Injury Report

Employee Consent Form

As a reminder, please inform your employees to report all work-related injuries immediately to their supervisors. RCUH must receive all work-related injury reports within 24 hours of occurrence of injury. Employees should refer to Policy 3.580 RCUH Workers’ Compensation and the Guidelines to Employees memo for more information on how their workers’ compensation claim will be processed and administered.


Please email me at [email protected] if you have any questions.