Seattle Department of Human Resources Bobby Humes, Director


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Event: You are Injured at Work

In the event you are injured at work, immediately contact your supervisor. Your supervisor will provide you with a packet that contains instructions on reporting your claim and forms you will need to take to your doctor. Please read all of the information and follow the steps below to ensure your all benefits due to you are paid timely:

Step 1 - Complete the Self-Insurer Accident Report
Fill out and sign the Worker section of the Self-Insurer Accident Report (SIF-2) Form included in the Worker's Compensation packet. Return it to your supervisor immediately. Keep the pink copy for your records. Your claim number is printed in the upper right hand corner of the form. Your doctor will need to know this number. You should also refer to it when calling about your claim.

Step 2 - See Your Heath Care Provider
Explain to your doctor that your injury or illness is work-related and the City is self-insured. Take the Activity Prescription Form (APF) and any light duty descriptions provided by your department for your health care provider to complete. Return this information to your supervisor immediately. This information will help to determine activities you are able to perform safely as you recover.

Step 3 - Report to Work
Provide the completed Activity Prescription Form to your supervisor. If you have been released to work with medical restrictions, your supervisor will identify duties which are within your restrictions.

Step 4 - Inform Your Supervisor if You are Unable to Return to Work
If your doctor says you are unable to report for work, inform your supervisor and turn in your Activity Prescription Form (APF) immediately (no benefits can be paid until this form is received).

You may also need to complete Long-Term Disability insurance paperwork.

Note: If you were involved in a vehicle accident or other action that you believe was the fault of another person - who was not an on-duty City employee at the time - you also need to fill out the "Third Party Election Form" and return it to your supervisor.