Workers Comp

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Worker's Compensation


Procedures for reporting work-related accidents and illnesses:

  1. A Notice of Accident form (half sheet) will be completed by the employee regardless of whether or not the employee seeks medical attention. The injured employee, immediate supervisor or employer’s representative sign and date the form. 

**The half sheets forms must be placed hanging at the bottom of the Worker’s Compensation Poster and the employees notified of where the forms are located. If you are out or need an updated poster please contact Human Resources.

  1. If an injury has occurred, the school or department must prepare the following Worker’s comp forms:
    1. Initial Report form.     
    2. Worker’s Authorization for Disclosure of Protected Health Information (HIPAA Form).   
    3. Workers' Compensation Basic Information Sheet. 
    4. Supervisor’s Evaluation of Occupational Injury or Illness
    5. Witness Statement of Workers’ Compensation Occurrence. 

Initial Report Form can be filled out by the site secretary, as she is the one who will enter the information into ICE. Please assist the employee as much as possible to ensure accurate information for E1 reporting.

Workers' Authorization for Disclosure of Protected Health Information. Please have the injured employee complete this form. Give the employee a copy, make sure paragraph 11 is checked “yes” when a copy is given. 

Workers' Compensation Basic Information Sheet. The injured employee must read and sign this form. Give the injured employee a copy after he/she signs the form.

Supervisors' Evaluation of Occupational Injury or Illness. The Supervisor must complete this form with particular attention paid to “Preventative/Corrective Action taken or recommended”

Witness Statement of Workers’ Compensation Occurrence. Please give to the employee to give to witnesses. The witness should turn the information to the designated site secretary to forward to Human Resources.

The designated site secretary will enter the information in ICE database, if question need to be answered or problems arise, please contact Donna Vann in Human Resources at 812-6057. 


Forward all forms to Human Resources as soon as possible. Failure to notify Cannon Cochran Management Services, Inc. (CCMSI) within the 15 day deadline will incur fines against the District. The Alamogordo Public Schools in no way advises, suggests, or designates medical providers. It is the employee’s responsibility to select a medical provider

  1. If an injured employee goes to a doctor, he/she must provide a work status report from the doctor stating whether they are restricted in capability or released to full-time duty. If an injured worker returns to work but has follow-up visits, they should provide doctor’s notes regarding their work status.  Please forward these as soon as possible to Human Resources 
  1. On the day of injury only, the site secretary will enter into ASEOP (the district Automated Substitute Placement & Absence Management ) as Worker’s Compensation (WC). The injured employee will not be docked for any time off on that day of injury. 
  1. Employees are responsible for the first seven (7) calendar days of leave and any intermittent time off. These first seven (7) calendar days are not paid for by Workers’ Compensation and will be charged to sick/personal days. If no sick or personal days are available, vacation may be charged. 
  1. If the employee is unable to work after those seven (7) days and miss more than twenty-eight (28) days, Worker’s Compensation will reimburse the first seven (7) days at your workers compensation benefit rate. CCMSI will begin Worker’s Comp benefits and they will be removed from payroll. Entries in ASEOP will be WC-Leave With Out Pay (LWOP).
  1. An employee who is eligible for Family Medical Leave Act (FMLA) will be placed on FMLA/WC. An employee may be on FMLA and WC at the same time as they may run concurrently.
  1. An employee who is out for a Workers’ Comp injury and is removed from payroll will be entered in by the site secretary as WC-LWOP or FMLA/WC-LWOP, if eligible.

Any Questions Contact: Donna Vann at 575-812-6057


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