Administrative Regulation 401.12A
Work Related Injuries
If you experience a work-related injury or illness…
- Report to your school office IMMEDIATELY.
- If your injury is critical or life threatening, your nurse or secretary will make arrangements to take you to the closest emergency room or call 911 for assistance.
- If you are not critically injured, the nurse or secretary will make arrangements for you at Work Fitness to treat your injury. They will give you an Employee Injury Packet, which provides all the information needed to successfully treat your injury.
- Included in this packet is the DCSD’s EMPLOYEE’S FIRST REPORT OF INJURY REPORT. Please fill out this form and return it to the nurse/secretary immediately.
- Complete the Work Fitness Authorization form with your nurse/secretary before you leave your building & present at the Check-in Desk when you arrive at Work Fitness. (Genesis Plaza – 2535 Maplecrest Road – Suite 27 – Bettendorf) A map is provided on back of the Work Fitness Authorization Form for your convenience.
- On completion of your exam, you must report to the checkout desk where you will receive a copy of your Work Status Summary Report. This summary will note any restrictions or follow-up appointments that may be necessary. A copy is also faxed to the DCSD’s Worker Comp.Office at the Operation’s Center. If a prescription is needed after completion of your exam, you may have it filled at the Work Fitness Center Pharmacy or you may take it to any Walgreen’s Pharmacy.
- Report back to your building nurse/secretary with your Work Status Summary Report to discuss your treatment and return to work plan. It should be noted that the Davenport Community School District has an active return to work program. If your doctor allows you to return to work with limitations, the district will find work within your physical restrictions somewhere in the district.
- DO NOT USE YOUR GROUP HEALTH INSURANCE MEMBERSHIP CARDif this injury or illness occurred while working or acting in an official capacity for the Davenport Community School District.
If you choose to be treated by any other treatment center and/or physician, you may not qualify for any worker’s compensation insurance benefits, and you may be responsible for all medical costs related to this incident. This is in accordance with our state Worker’s Compensation statute.
IF YOU HAVE ANY QUESTIONS ABOUT YOUR CARE, TREATMENT,
AND/OR FORMS PROCESSING, CONTACT:
1008 W. KIMBERLY ROAD
TELEPHONE: 386-4780 FAX: 386-9810
If you have reason to be dissatisfied with the care offered,
you have the right to contest your employer’s choice of physician.
This can be done by contacting the Iowa Industrial Commissioner’s Office.
- Revised 6/96, 7/99, 7/03