Workplace Safety

First and foremost, ensure treatment for the Injured Employee:

• Call 911 for serious injuries and life threatening emergencies. If the emergency is in the Raleigh area, calling 911 will alert University Police and Fire Safety services. Additionally, if there is death, hospitalization, amputation, or loss of an eye, immediately report to Campus Emergency Services (919-513-3000). The University is required to report this information to regulators.
• For non-serious injuries or incidents, go to an Authorized Medical Facility.
• Student employees should go to Student Health Services

Supervisor’s forms to complete (take the forms with the injured employee for the physician to complete):

• NCSU Supervisor’s First Report of Incident – Combination incident report and investigation form.
• Supervisor’s Medical Treatment Authorization Form (Not required for a medical emergency)
• Non-Employee Incidents – For incidents involving visitors or students, a the supervisor or other university staff should complete the “Student/Visitor Incident Report form” found on the Insurance and Risk Management website. Do not use this form for employee incidents. Please follow the instructions provided on the form.

Employee’s forms to complete:

• Workers’ Comp Employee’s Statement Form 
• Workers’ Comp Use of Leave Option Form 

Send all completed forms within 24 hours to:

NC State HR Workers’ Compensation (WorkersComp@ncsu.edu) AND NC State EHS – Occupational Safety (AccidentReport@ncsu.edu)

Help with Forms

• Incident Report Forms Flowchart
• Post-Accident Checklist
• Contact Environmental Health & Safety for assistance with incident investigation and forms completion (919-515-7915 / accidentreport@ncsu.edu)
• Contact Workers’ Compensation for assistance with obtaining medical treatment, medical claims, physician contacts, billing, and forms completion (919-515-2151 / workerscomp@ncsu.edu)

 

Authorized Medical Facilities

Rx Urgent Care
3100 Blue Ridge Rd
Raleigh NC
Phone: 919-719-2250

Next Care Urgent Care
1110 Kildaire Farm Road
Cary, NC 27511
Phone: 919-481-0277

Student Health Services (Postdoc and Student workers only)
2815 Cates Avenue
919-513-2563 919-513-2519 Fax

If Authorized facilities are closed or if the injury is serious, Go to the Nearest Hospital.

Non-Local: For employee injuries outside the Raleigh area, take employee to nearest Urgent Care Center. If facilities are closed or if the injury is serious, Go to the Nearest Hospital.

Additional Accident Resources

• HR – Worker’s Compensation Information
• Blood or Body Fluids Post Exposure Process
• Non-clean Sharp Objects Injuries including Needle Sticks
• Rabies Exposure or Animal Bite Instructions

Information regarding Accident Reporting retrieved from Environmental Health and Safety Center’s website.