Academic Affairs Manual (ACD)

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ACD 601–06 Table 2

The faculty member or academic professional notifies the supervisor of the injury immediately, if possible, and reports to the Campus Health Service for treatment, if possible. He or she completes and signs the appropriate portion of the Workman’s and Physician’s Report of Injury form at the Campus Health Service or at the attending physician’s office.

The Campus Health Service completes and forwards the form to Human Resources (HR).

The supervisor completes sections 1–32 of the Employer’s Report of Industrial Injury form. If the answer to section 28 is “yes,” the supervisor attaches an explanation and signs and dates the form.

The faculty member or academic professional:

  1. obtains the Employer’s Report of Industrial Injury form from the supervisor and signs and dates the Assignment of Possible Compensation form

    and

  2. notifies the supervisor whether absence should be charged to vacation leave after accrued sick leave has been used.

The department forwards the forms to HR.

HR:

  1. completes sections 33–52 of the Employer’s Report of Industrial Injury form

    and

  2. transmits the appropriate paperwork to Arizona Risk Management and to the Industrial Commission of Arizona.

If the faculty member or academic professional is using accrued sick leave and, if desired, vacation leave, the supervisor or designee submits the Absence Report for the faculty member or academic professional.

If the faculty member or academic professional has exhausted accrued sick leave and, if desired, vacation leave, the supervisor or designee docks the faculty member or academic professional’s pay per policy.

HR processes the faculty member’s or academic professional’s paycheck.

The faculty member or academic professional obtains a statement of release from the attending physician to present to the department before returning to work.

Return to ACD 601–06.

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