IUPUI or IU Employees

Please bring or fax the Occupational Inury/llness report form (both pages) to IUPUI Campus Health.  Failure to turn in the forms within 7 days may result in claim denial.  

Step 1 Notify supervisor of injury or exposure immediately.

Step II Provide written notice within 7 days of Injury.  Download and complete the Occupational Injury/Illness form.  The second page is an Authorization for Medical Records. 

Step III Print and complete the appropriate form
Needlestick and Sharp Object Report
Blood and Body Fluid Exposure Report

Step IV Fax the completed forms to IUPUI Campus Health at 317-278-6929 or email the forms to healthsv@iupui.edu  attention Tina Coffin. 

IU Health/IUHP Employees
Team members are required to report any on-the-job injury or illness to your department management and occupational services within 24 hours of the occurrence.  Failure to report within this time frame may result in a delay in treatment or claim denial.  

Step I  Notify supervisor of injury or exposure immediately.  

Step II Complete the EIER immediately following any work-related injury.  (Type EIER into the Search box).  Fax the form to 317-278-6929 (attention Tina Coffin) or email it to tmcoffin@iu.edu

Step III Complete the IUH Blood/Body Fluid report.

Step IV Report to Coleman Hall for an initial health assessment. 

• Emergency care after the clinic is closed may be provided at an IU Health Hospital Emergency Department
• If hospitalized, notify EOHS and IU Health Worker's Compensation Department
• Direct questions to workerscomp@iuhealth.org, fax to 317-968-1318 or call 317-963-4102.