Workers' Compensation

It Works For You

Rememeber that ALL work related accidents should be reported, even if the employee does not seek medical attention.

 

IMPORTANT INFORMATION FOR FILING A WORKERS' COMP CLAIM

 

 

Click below for the list of Workers' Comp approved healthcare providers:

 

PRIME HEALTH Primary Care Provider Directory

 

 

Workers' Compensation Forms

The following three (3) forms must be filled out for every work-related accident.

  1. State of Tennessee Accident Report (PDF Format - Legal Size Paper)
  2. Supervisor's Report of Employee Accident (Excel format)
  3. Initial Medical Information Checklist (Excel format)

First Fill Form

The First Fill form must be given to each employee.

 

Lost Time/Return to Work Calendar (Excel format)

*****Calendar needed only if workdays were missed after date of accident.****

 

Supervisor's Checklist (Excel format)

*****Checklist for Supervisor's reference and file only.*****

 

These forms can be filled out on the computer and printed. All forms can be saved except the State Accident Report, which is in PDF format, which requires Acrobat Reader 4.0 or higher.  The form will be downloaded to your computer and can be opened and filled out multiple times, but additional information cannot be saved. You will get a "blank form" each time. (Go to www.adobe.com to download the latest version of Acrobat Reader.)

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