Instructions and Forms for OJI

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Instructions for Department Supervisors
This file contains basic information for Supervisors. If you have questions, please call 205.934.4458.

Initial Medical Evaluation Authorization
The Supervisor should complete this form and send it with the employee to The Workplace for medical treatment.
(If injury occurs after hours or in event of life-threatening injury, send the employee to the University Hospital Emergency Department)

OJI Incident Report
If you have access to Trend tracker (the electronic incident reporting system), do not use the paper incident report.
If you do not have access to Trend tracker, the paper incident report form must be completed by employee and signed by supervisor to be forwarded directly to:
Leticia Waldon
AB 216

If employee is unable to complete the form, the supervisor can complete it.

How to Apply for OJI Benefits
This form contains information for the employee about the OJI Program. The injured employee should read this form carefully.

OJI Benefits Application
An employee applying for OJI Benefits must fill this form out completely in order to be considered.

Release of Information
This form should be filled out by the employee. Any incomplete or altered forms will result in a delay of the claim process.

OJI Time Sheets
The Supervisor should complete this form on the eligible biweekly employee and forward in a timely manner to avoid delay in payment of lost time wages.