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 IV Fax the completed forms to IUPUI Campus Health at 317-278-6929 or email the forms to firstname.lastname@example.org 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 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 email@example.com, fax to 317-968-1318 or call 317-963-4102.