First Report of Injuries - Packet of Forms for Staff & Supervisor
Your Packet includes:
New Reporting Information - If you are unsure about seeing a doctor for your injury, please call the
EMC On-Call Nurse at 1-844-322-4668. You will be able to ask questions and be advised what to do.
If it is an emergency - dial 911.
1. Supervisor's Report Form - complete and fax to 507-387-4033.
2. Employees' First Report of Injury Form
*When both forms are 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 your injury.
If you have any questions for CorVel, you can contact the
CorVel Access Line at 612-436-2500 or 877-703-4241.