IF THIS IS AN EMERGENCY, CALL 911 IMMEDIATELY. DO NOT COMPLETE REPORT AT THIS TIME.
You can Report any of the following incidents:
- UA Employee injuries (including student employees)
- Non-Employee injuries (including students)
- Unsafe Conditions
- Damaged Property
- Damaged Vehicles
IF YOU SEEK MEDICAL ATTENTION please fill out the Report of Occupational Injury or Illness form in addition to the report in Origami.
EMPLOYEE - Within 10 days of the injury/illness, the employee must complete and submit the “Employee Report of Occupational Injury and Illness to Employer” form (07-6100).
Must be filled out by employee
EMPLOYER - Within 10 days of injury/illness, the employer (supervisor) must complete and submit the “Employer Report of Occupational Injury and Illness to Division of Worker’s Compensation” form (07-6101). Please note: In block 1 of this form, UAF is the employer. In block 3, the employer contact is the injured employee’s supervisor.
Must be filled out by employee's supervisor
If the drop down menus do not work, try saving document to your desk top.
Each completed form MUST be printed, signed, and faxed to both SORS at 907-786-1412 and UAF EHSRM at 907- 474-5489.
The System Office of Risk Services will file the completed forms with the Alaska Worker’s Compensation Division on behalf of the employer. Please contact SORS at 907-786-6119 or 786-1716, if you have any questions regarding these changes or encounter any problems when completing these forms.