Louisiana Department of Education

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Special School District

Work-Related Injury Reporting & Worker’s Compensation Guidelines


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Requirements

The purpose of this section is to outline the specific requirements for reporting any work-related injury. Employees are required to immediately report all injuries or incidents sustained on the job to their supervisor or designee. It is expected that an employee will report the injury to the supervisor before seeking medical treatment; however, when not possible, notice of injury may be given or made by anyone on behalf of the injured employee.

The supervisor or designee must notify the Special School District (SSD) Central Office Human Resource Manager I, Erin Tullier or her designee via email immediately when an employee is injured. Ms. Tullier will then process the report of injury to the appropriate Human Resources staff. The notification must include the following pertinent information:

  • Employee’s Name
  • Date of Injury
  • Time of Injury
  • Location of Incident
  • Identify the Need for Immediate Medical Attention

In the event medical treatment is required, Human Resources staff will be available should the treating facility have concerns. Further, the treatment facility will be provided with contact information for SSD and Human Resources for any future correspondence or communication.

The following forms shall be submitted to the SSD Central Office Human Resource Manger I:

  • Employer Report of Injury/Illness Form (within three (3) working days of the incident to be completed by the supervisor or designee)
  • Office of Risk Management, Unit of Risk Analysis and Loss Prevention Incident/Accident Investigation Form (within five (5) working days of the incident)
  • Employer’s Supplemental Report of Injury Form (completed upon return to work)

In the event there is no work missed, the Employer’s Supplemental Report of Injury Form shall be completed indicating “No Time Missed from Work.”

All absences for work-related injuries are coded “LD” unless otherwise noted by the Human Resources Manager I. In the event the supervisor believes the absence(s) may qualify as a potential FMLA situation, the appropriate documentation shall be completed. To prevent prior period pay adjustments, effective communication shall take place among the SSD Central Office, the supervisor, and the site time administrator.

Please find the following enclosures for your reference: LDOE Policy No.EP 6.1 Worker’s Compensation; Policy No. EP 6.2 Return to Work; Employer Report of Injury/Illness Form; Incident/Accident Investigation Form; and, the Employer’s Supplemental Report of Injury Form.

Regional Coordinators shall ensure that these processes have been reviewed with all staff under their supervision.

For more information contact:
Erin Tullier  

erin.tullier@la.gov
225-342-3545
Scott Richard  

scott.richard@la.gov
225-342-6904

Forms

This links to the semi-interactive form which allows for completion and printing from online. It must be submitted to the appropriate supervisors within three (3) working days. This is the preferred version of the form and is the responsibility of the site supervisor or designee.
DA 1973

Click Here for Microsoft Word version of DA 1973.
Employer Injury_Illness Report  Word

Click here for Adobe Acrobate version of DA 1973.
Employer Injury_Illness Report  PDF

Form DA 2000 - This form must be completed and submitted within three (3) working days of any incident. This form is the responsibility of the supervisor or designee.
Incident_accident_investigation  Word

DA 1973 - This form must be completed and submitted upon employee's return to work.
In the event there is no work missed, the Employer’s Supplemental Report of Injury Form shall be completed indicating "No Time Missed from Work.”

Injury Illness Supplemental Report  Word

This form is submitted as documentation of injury resulting from assault, battery or physical contact. The form is a guide for the required information and is not mandated. The identified information must be included as part of the statement submitted to Human Resources.
Certification of Injury  Word

This form is associated with medical approval for return to work.
Return To Work  Word