Worker's Compensation

Workers Compensation

Accident Form Instructions 

  • Immediately report any injury to your supervisor, even if the injury seems minor.                                                                                                      (You may lose your rights if not reported promptly.)
  • Fill out the workers compensation accident form and return it to the Human Resource office by the end of the shift or within 24 hours of accident.
  • If the injury occurs on a weekend, please submit the accident form to the HR office by Monday morning.
  • If medical treatment is necessary, inform the physician or hospital that it is a work related injury.  This helps insure that your visit is properly billed and not delayed.  An excuse from work or a release back to work notice is required.  
Return Forms to:
Kelli Stevens, HR Assistant                                                   Craig Blake HR Director
Phone: 435-893-0409                                                              Phone: 435-893-0459
Cell: 435-201-1726                                                                    Cell: 435-979-6580
Fax: 435-893-0495                                                                    Fax: 435-893-0495                                               

*   Supervisors must contact the Human Resource Department immediately if a claim appears to be suspicious or questionable or if the accident resulted in a fatality.

Worker's Compensation Claim Form -Sevier County Accident Report

Utah Counties Insurance Pool (UCIP)