Injury & Illness Reporting Policy

Basic information


This policy is designed to assist employees with the reporting work-related injuries.


Employees will be provided a safe and healthy work environment. Employees who are injured on the job will receive assessment and treatment, if appropriate, in order to ensure recovery and a prompt return to work. All injuries, no matter how minor, must be reported the day of the injury. The employee is responsible for initiating the process and must notify his/her immediate supervisor of the incident. The supervisor is responsible for monitoring the incident reporting process and ensuring the report gets to the Environmental Health and Safety (EHS) department within 24 hours.


Injured Employee

  • Employee includes part-time, full-time and student workers. Volunteers, visitors and guests who are injured on campus may also use this form unless Campus Safety is contacted and completes their incident report form.
  • Report any injury or illness immediately, and no later than 24 hours post-injury, to your immediate supervisor and notify EHS ( or 526.6342).
  • Complete the incident report form which is available from the EHS department or online at the EHS website. Have your supervisor sign the report form and then send to EHS.
  • If medical attention is needed, contact Campus Safety at 3-3333 (campus phone) 616-526-3333 (cell or off campus phone). Campus Safety will respond and provide aid. If an ambulance is needed, Campus Safety can arrange for emergency medical care.
  • If non-emergency medical care is required beyond the abilities of Campus Safety first responders, the injured employee may seek care at Med-1. The injured person needs to drive themselves if able or arrange for transportation. Due to liability issues, EHS and Campus Safety generally do not transport employees to Med-1.
  • Provide EHS with any Med-1 documents.

Supervisor of Injured Employee

  • Perform incident investigation as promptly as possible to determine root cause(es) associated with the injury or illness. This may be completed in conjunction with the EHS department.
  • Implement corrective actions to reduce the exposure/risk of injury and to prevent future incidents.
  • Implement progressive disciplinary action if the root cause was determined to be the result of the employee’s engagement of unsafe work practices or disregard to safety rules.

Campus Safety

  • Responds to calls for medical care.
  • Provides response reports to EHS.

Environmental Health and Safety

  • Assists with incident investigations.
  • Files workers compensation claim for injured employee.
  • Provides Med-1 documentation and incident report to workers compensation insurance carrier.
  • Communicates any work restrictions to the employee’s supervisor.
  • Notifies Human Resources if the injured employee will miss time from work.
  • Requests 52-week wage information from Payroll if the injured employee will miss more than seven days of work.

Workers Compensation

Workers' compensation is the system Michigan uses to provide wage replacement, medical, and rehabilitation benefits to individuals who are injured while at work. To be compensable, the injury must happen at work. Workers' compensation is designed to cover only injuries which "arise out of and in the course of the employment."

During the first 28 days of medical treatment, the employer has the right to choose the doctor. At Calvin, employees with work-related injuries are treated at Med-1. After that, the employee is free to change doctors if he or she so desires. However, the employee must notify the Environmental Health and Safety of the change.

If it appears that the disability will last for more than one week, Broadspire, Calvin workers compensation insurance carrier, will file an Employer's Basic Report of Injury (Form WC-100) with the Workers' Compensation Agency. There is a 7-day waiting period for benefit payments. Calvin will provide your benefits if you are off work for less than 14 days (You must be eligible for sick time. If you are unsure, check with Human Resources). If you lose more than 14 days of work, Calvin’s workers compensation insurance carrier will arrange for wage-loss benefits. Benefits are based on the wage loss and set at 80 percent of the after-tax value of the loss.


Jennifer Ambrose (616) 526-6342


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