First Report of Injuries - Packet of Forms for Staff 

 



 
Your Packet includes:
 
1.    First Report of Injury Form 
*When complete, fax to the District Facilities Director as soon as possible*
Fax:  507-387-4033           Ph: 507-345-5311
 
2.    Supervisor’s Report of Injury Form
*When complete, fax to the District Facilities Director as soon as possible*
Fax:  507-387-4033           Ph: 507-345-5311
 
3.    CorVel Certified Managed Care Plan
        for Workers’ Compensation Injuries  *For Your Information*
 
4.    Medical Providers under the CorVel CMC Plan  
 
5.    ˜ “Patient ID Information” ˜ attachment:
        Write in your Name and Social Security Number
        and give this to the doctor you see for this injury.
 
If you have any questions for CorVel, you can contact the
CorVel Access Line at  612-436-2500 or 877-703-4241. 
 
 
 

 
 
 

 First Report of Injury File Type View File Download File
FROI Packet
Packet includes: Staff First Report of Injury, Supervisor's Report, EMC Workers Comp. Insurance Company & Corvel, Clinic Phone Numbers and Who to call if you have questions.
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