Accident Reporting Kit
The chart below indicates the forms required to report a work related injury or illness and the responsible party for the completion and disposition of each form.
Instructions: Print out the appropriate form and complete. Send original to The Office of Risk Management, 2025 F Street, Suite 101 or fax to: 202-994-0130.
| Form No. |
Title of Form and Explanation |
Responsibility |
| WC GUIDE (PDF) |
A Guide to Filing a Workers Compensation Claim |
|
| ORM-0 (PDF) |
Common Questions about Workers' Compensation |
|
| ORM-1 (PDF) |
Responsibilities for Filing a Workers Compensation Claim
(Instruction sheet to be used by the supervisor and employee) |
Supervisor & Employee |
| ORM-2 (PDF) |
The George Washington University Office of Risk Management Accident Reporting Form
(To be completed by the supervisor and submitted by the end of the work day following the day of injury) |
Supervisor |
| ORM-3 (PDF) |
The George Washington University: Authorization for Medical Treatment
(Authorizes the injured employee to be treated at the GW Emergency Room or Student Health Services WHEN signed by the supervisor) |
Supervisor |
| DCWC Form 7 (PDF) |
Employee's Notice of Accidental Injury or Occupational Disease
(To be completed within 30 days from the date of injury or onset of illness. This form may be forwarded to the Office of Risk Management for mailing, if desired) |
Employee |
| DCWC Form 7A (PDF) |
Employee's Claim Application
(This form may be forwarded to the Office of Risk Management for mailing, if desired) |
Employee |
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In This Section
Insurance & Claims Management
Laptop Computer Theft
Motor Vehicle Operators
Workers' Compensation
International Travel Insurance
Many of the documents on this site are in PDF format.
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