Accident / Injury Reporting

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Forms referred to through-out these processes can be found by clicking the link above. They are also listed in our Forms and Documents Library.

 

Worker’s Compensation Claims – Building level Procedures  

(Injured Employees1  only)

The FCSU and its member schools has a Workers’ Compensation Insurance Program which may provide for payment of medical expenses and lost wages for employees who experience an identified work-related injuries or illness. Our insurance provider and administrator is VSBIT’s Multi-Line Inter-municipal School Program.

Initial Reporting and Medical Treatment    

The Employee, school nurse, immediate Supervisor or other designee must:  

Complete the FCSU EMPLOYEES FIRST REPORT OF INJURY Form

  • Immediately or ASAP and always within 24 hours of the incident
  • Getting initial information to the Benefits Coordinator is most urgent – residual information or signatures can be forwarded after the fact
  • FAX the form to the FCSU, Attn: Benefits Coordinator at 524-1540

and, if the employee needs to be seen at Northwest Occupational Health, give them a completed “Service Authorization” From.


If medical attention is necessary due to a work related injury:

Get a “Service Authorization Form” from the forms menu above and with that in hand,  proceed to (making an appt is preferable) :

Northwestern Occupation Health

Cobblestone Health Commons

260 Crest Road, Suite #101

St. Albans, VT  05478

P:  524.1223

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Work-Related “911” Conditions which should be directed to the Emergency Dept:

  • ELECTRICAL INJURY- with chest pain, large burns or confusion
  • LOSS OF CONSCIOUSNESS- for any reason
  • FALLS- with neck or back pain requiring ambulance transportation
  • LACERATIONS- large/uncontrolled bleeding

Although we encourage follow up medical visits to NOH, an employee may change doctors after the initial visit by completing the Notice of Intent to Change Health Care Provider and submitting it to Franklin Central Supervisory Union, Attn: Benefits Coordinator.

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1 Purchased Services workers are not our employees and should report accidents to their employer. Purchased Services workers are those such as food service, NCSS, bus drivers, etc. Please do notify your benefits coordinator of the incident for risk management purposes.

Lost time from work  

The first (3) three days are treated as “WC/S” [workers compensation / sick] and the time is deducted from available sick time. 

                                                         Tip: write wc/s on your timesheet.

After the first (3) three days, any time missed is recorded as “WC” on the timesheet. The employee will not receive wages from the school as the Workers Compensation comprehensive payment may be active at that point.

In the rare case that an employee is out for WC for greater than (10) ten days, the employee may be eligible to receive wages from the insurance plan for the first (3) three days that have already been paid as sick time. In this case, the employee must return the gross wages that they have received for the (3) three WC/S days and those three (3) days will be reinstated to the employees sick time.

Medical Certification / Billing

If a provider asks for billing information, give them the insurance carrier information below:

VSBIT Multiline Program

52 Pike DriveBerlin, VT 05602

P: 802.223.6132, F: 802.223.6135

For claim specific information such as a claim number or adjuster name they will have to speak with the FCSU Benefits Coordinator at 524.2600.

A Certification of Health Care Provider is required if the injury results in lost time and for consideration for extended rights under the definition of a “serious health condition” under the Family Medical Leave Act (FMLA) and/or the Vermont Parental and Family Leave Law (VPFL).

If the employee’s injury results in lost time, and/or medical treatment beyond first aid, the employee must provide a Return to Work form prior to resuming duties. The form must be received by the Benefits Coordinator.   

General Liability  –  Building Level Procedures

(Everything except injuries to employees and automobile losses) 

 ♦ Complete the FCSU GENERAL LIABILTY REPORT (Notice of Occurrence) form for all injuries to non-employees (parents, public, contractors, etc) 

 ♦ Complete the FCSU PROPERTY LOSS REPORT form for losses or damages to property 

 ♦ Complete the FCSU STUDENT ACCIDENT REPORT for all injuries to students 

 

FCSU FAX 524-1540

 


General Liability and Property Loss reports, in all cases:

  • Immediately or ASAP and always within 24 hours of the incident
  • Getting initial information to the SU is most urgent – residual information or signatures can be forwarded after the fact

 

Student Accident Reports are to be maintained at the building level unless extenuating circumstances exist. In all cases where an injury is serious, life threatening, or alleged to be caused by negligence on behalf of the school or its employees the form is to be forwarded to the central office as defined above. The school nurse, when in doubt, should err on the side of submitting the case to the SU.

Immediately take necessary steps to prevent further damage/Injury
 

Auto Loss Claims – Building Level Procedures    

[motor vehicles owned by the school]

♦ Complete the FCSU AUTO LOSS REPORT
– Immediately or ASAP and always within 24 hours of the incident
– Getting initial information to the SU is most urgent – residual information or signatures can be forwarded after the fact


♦ The Operator of the vehicle needs to complete the State of Vermont, DMV, Report of a Motor Vehicle Accident and forward according to the directions in that forms instructions.


♦ Fax both forms to the FCSU at 524-1540