Human Resource Administration

Leadership on all human resource-related issues

80 Lower College Road, Kingston, RI 02881

urihr@ucs.uri.edu401.874.2416 - 401.874.5741 (fax)

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Rhode Island Seal

Date: May 1, 2006 (revised)



 1. To identify and help prevent employee incidents and injuries.

2. To facilitate the processing of Workers’ Compensation benefits.

3. To ensure thorough reporting and investigation of employee incidents and injuries.

4. To help managers facilitate employee’s recovery from work-related injuries.


All employees


See Procedures


 Employees will be provided a safe and healthy work environment. Employees who are injured on the job will receive assessment and treatment, if appropriate, in order to ensure recovery and a prompt return to work. Workers’ Compensation benefits will be provided in accordance with Rhode Island Law. This will be accomplished by:

1. Affirmative efforts of the University’s managers to prevent employee injuries.

2. Prompt diagnosis and treatment of work-related illnesses and injuries.

3. Timely submission and analysis of accident/incident reports.

4. Injured employees will in most instances report to the designated health care facility for the initial evaluation.

5. Employees may elect to receive treatment from the physician of their choice.

Any incident or injury to employees must be reported on the URI Incident/Injury Report Form (USP-14A) immediately following the incident. All injuries, no matter how minor, must be reported. The employee is responsible for initiating the process and must notify his/her immediate supervisor of the incident. The supervisor and the department manager are responsible for completing and monitoring the incident reporting process.


Employee Responsibility:

 1. Employee reports incident to immediate supervisor and then to department manager, and completes Employee Report section of the URI Incident/Injury Report Form (USP-14A). When form is completed and signed, the employee gives it to the supervisor for completion.

2. If treatment is needed, or an examination is desired by the employee (see *NOTE below), employee reports to the designated treatment facility (if unable to drive, transportation will be provided by the University).

Employee presents GOLD copy of the incident form to designated treatment facility.

Kingston and Bay Campus – Employees report to South County Hospital.

W. Alton Jones – Employees report to nearest medical treatment facility.

Providence Campus – Employees report to Corporate Care at St. Joseph’s Hospital.

 Department Manager Responsibility:

3. Completes Manager’s section of URI Incident/Injury Report Form detail, and signs. Ensures all information in Employee Report section is provided, and indicates whether employee had lost time from work.

The Department of Labor and Training requires that a copy of the report be received in their office within 10 days of an incident. Therefore, the department must send completed URI Incident/Injury Report to the Office of Human Resource Administration promptly. Failure to do so may result in a $250 fine which will be charged to the department.

If injury requires an examination, or if employee desires an examination, send employee to designated treatment facility with the GOLD copy of the completed URI Incident/Injury Report form. The WHITE & YELLOW copies are sent to the Office of Human Resource Administration, Employee Benefits Section within 24 hours of the incident.

If no examination is to be done, forwards completed Incident/Injury Report form to the Office of Human Resource Administration, Employee Benefits Section, Room 21, 80 Lower College Road, Kingston before the end of the shift on which the incident was reported.

If an employee has suffered a serious injury, he/she should be taken directly to the nearest emergency health care facility. All paperwork should be completed as soon as possible thereafter.

Office of Human Resource Administration, Employee Benefits Section Responsibility:

4. Date stamps and reviews URI Incident/Injury Report form for completeness and ascertains whether further information is required. Forms found to be incomplete will be returned to the department.

 5. Completes First Report of Injury Form and processes compensation claim. Sends completed report to Division of Workers’ Compensation.

 Risk Management Officer Responsibility:

 6. Investigates work-related illnesses or injuries concurrently with the submission of the manager’s report of injury. Collects information about incidents involving lost time, interviews any witnesses, recommends action to prevent recurrence.


Medical documentation must be provided when an injury involves first aid, medical treatment, musculoskeletal symptoms, or when the employee’s duties must be altered or restricted.


Sick Leave / Payroll Discharge Form

Employees Certificate of Dependency Status

Authorization for Release of Confidential Information

URI Incident/Injury Report (USP-14A)


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The University of Rhode Island
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