Initial Notification of Injury Form

When a workplace injury occurs, the injury must be reported to the employer as soon as possible. Completing this short questionnaire used to notify ASU Office of Human Resources and Environmental Health, Safety & Emergency Management (EHS&EM) personnel. You will also be provided access to the latest, up-to-date injury report forms needed to get Workers’ Compensation (WC) benefits to the injured employee and to have the accident investigated in hopes of avoiding future like incidents. If you should have questions, please call Wanda Yates, WC Administrator at 828-262-6488 or Ronnie Riddle, Occupation Safety Manager, EHS&EM at 828-262-7649.

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Be sure to include phone number, email address, or other means of contacting injured employee.
Be sure to include phone number, email address, or other way to contact you.
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