Employee Forms

Employee's Report of Injury (SORM-29) [English] [Spanish] – The employee must complete this form immediately after sustaining a work-related injury. The form should be submitted to the Claims Coordinator who forward a copy to the State Office of Risk Management (SORM)

Authorization for Release of Information (SORM-16) [English] [Spanish] - The employee must complete this form immediately after sustaining a work-related injury and submit to the Claims Coordinator who will forward a copy to SORM.

Employee Election Form (SORM-80) [English] [Spanish] - The employee must complete this form immediately after sustaining a work-related injury and submit to the Claims Coordinator who will forward a copy to SORM.

Workers Compensation Network Acknowledgement Form: [English] [Spanish] - The employee must complete this form immediately after sustaining a work-related injury. The form should be submitted to the Claims Coordinator who will forward a copy to the State Office of Risk Management (SORM).

Employee Network Notification Packet: [English] [Spanish] - The employee network notification packet provides employees with information on how to get health care under the workers’ compensation program. Please read the packet before signing the Workers’ Compensation Network Acknowledgement form which can be found directly above or in the Employee Network Notification Packet. Additional information can be found on SORM’s Health Care Network webpage. You may also view the Network Frequently Asked Questions document.

Supervisor Forms

Supervisor’s First Report of Injury or Illness [English] – This form shall be completed by the injured employee’s supervisor or their designated representative and submitted to the Claims Coordinator within 24 hours in order to meet state stipulated deadlines. Failure to submit the necessary forms on a timely basis may delay medical and income benefits to the injured employee and may result in administrative fines to the University.

Witness Statement (SORM-74) [English] [Spanish] - The form must be completed by each witness to the accident. The injured employee's supervisor or designee should forwarded the statements to the Claims Coordinator.

Injuries Sustained Abroad

Foreign Workers' Compensation Coverage Should you sustain an injury in another country while on University business, contact the Workers' Compensation Specialist in the Risk Management department immediately. Risk Managment will need a full accounting of the incident, and will file the claim accordingly dependent upon the claim information provided.