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Employee Incident Reporting

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Workers' Compensation Trust: Employee Incident Reporting

Your School District has opted to self-insure its workers’ compensation program so injured employees will receive the benefits available to them in an efficient and expedient manner. If you are injured on the job the WCT will manage your claim. As an employee of an ESD 113 WCT member school district, you are covered under the Washington State Industrial Safety and Health Act (RCW Chapter 49.17). This law specifically requires that you comply with all safety and health standards which apply to your actions on the job.

What to do if you are injured on the job:

1. Report the accident or injury to your supervisor, and complete an Employee Incident Report (EIR) form online at, or obtain a form from your supervisor or district designee to complete.

2. Not all injuries require medical treatment. IF you need to go to a medical provider call the WCT at: (360) 464-6880 to report the injury and get a claim number.

3. Tell your treating medical provider that your employer is self-insured. Ask them to fax or mail a Provider’s Initial Report (PIR) to WCT. Fax: 360-464-6907.

4. If you cannot return to your job your medical provider must certify all restricted duties and/or time off work.

Note: Washington State Law requires an injured worker see a Labor and Industries Medical Network approved provider for care a`er the ini9al office or emergency room visit.

Safety Responsibility:

EMPLOYEES-You are responsible for your safety at work. You must do your job safely for the protection of you and those around you.

SUPERVISORS-You are responsible to make sure safety is a part of each employee’s responsibilities. You should continually monitor work environment for poten9ally harmful situa9ons. You should also ensure staff is trained appropriately on equipment and PPE.

ADMINISTRATION-You are responsible for providing a safe working environment for employees. This covers all aspects of the school district operation. Pursuing an effec9ve safety program and the development of a positive safety attitude in all the employees in your district is paramount in maintaining a safe work place.

SAFETY COMMITTEE-The safety commitee’s responsibility is to evaluate and monitor the working environment and the work prac9ces of the employees in your district. The commiTee will review Employee Incident Reports (EIR) and investigate accidents and hazardous practices to determine where training or repair is necessary for employee safety.

Remember: In accordance with RCW 51.28.010, employees are required to report all accidents or injuries immediately. Failure to do so may jeopardize your benefits. Any injury regardless of severity should be reported.