TO REPORT AN ON-THE-JOB INJURY, THE INJURED EMPLOYEE SHOULD CALL THE EMPLOYEE INJURY CALL CENTER AT 877-764-3574 AND SPEAK WITH A REGISTERED NURSE. THIS SERVICE IS AVAILABLE 24/7, TOLL FREE.
If the employee injury call center is NOT called to report the injury, please use this form to notify key personnel immediately of the injury. This form should also be used to report any accident, exposure or other occurrence where there was no injury/illness, and in near miss accidents. Complete at least those entries with an asterisk in order to submit the form successfully.
LSU RISK MANAGEMENT
THIS FORM MUST BE SUBMITTED IMMEDIATELY