When an employee is injured at work:


o Notify Matt Hirsch, Central Office, when a staff member is injured.

o Complete Supervisor’s Accident Investigation Report.

o Send both Supervisor and Employee incident reports to Matt Hirsch, Central Office.


o Complete Report by Injured Employee.

When an employee needs medical treatment:


(fill out these typeable forms and give to employee to take with them)

o Complete Registration/Treatment Consent through Injury Accident section. The employee MUST take this form to care provider when seeking medical treatment.

o Complete Temporary Prescription ID Card. Employee takes this to a listed Pharmacy if the doctor prescribes a medication when they receive initial treatment.


o Get the two forms listed above from your administrator before leaving for treatment.

o Take the Registration/Treatment Consent form to:

• Between 7:00 AM­4:00 PM: Employee needing medical treatment will go to St. Francis Occupational Medicine Clinic, 2nd Floor, 631 Horne, Topeka,

• After 4:00 PM: Employee needing medical treatment will go to St. Francis Health Center Emergency Room, 1700 SW 7th, Topeka.

o If you need a prescription filled take the Temporary Prescription ID Card to one of the pharmacies listed on the back page of the form.

When an employee returns to work:


o Present medical release from a medical care provider to your supervising administrator before returning to work.

Physician should note any work restrictions on the release.


o Forward medical release to Matt Hirsch, Central Office.

Download PDFs Below:

Workers' Compensation Procedures (PDF ­ 38 KB)