Location & Mailing Address:  
Administration Building, Suite 215  
701 20th Street South  
Birmingham, AL 35294-0103  


Phone: 205.934.4458
Fax: 205.934.1407
Email to: OJI


The OJI Division is organized as follows:

Anita Bonasera, SPHR HR Executive Director 205.934.4458
Leticia Tatum On The Job Injury/Illness Program 205.934.4458
  Brentwood Services Administrators 205.933.0373

PLEASE NOTE:The forms on this page must be completed only with the Adobe© Reader. Using other programs will result in lost data on the form. Some of the forms can be completed and saved to your local drive. The reader is a free download from Adobe.com. Click on the icon below to get the free Adobe© Reader:


Instructions for Department Supervisor
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 Tatum
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.


The OJI/Illness Program is responsible for coordination of benefits payable (medical expenses and lost wages) to any employee who may have an injury/illness sustained in the course of, and arising out of, employment at UAB.

Instructions and Forms for OJI
This link will take you to the instructions and forms necessary to handle an OJI incident. Please review them carefully.

If you have an injury requiring medical treatment that would cause a bill to be generated, you MUST fill out an OJI Application for Benefits form as well as a Release of Information form. The Trend Tracker Incident Report must also be completed before any bills will be paid.

To report an incident:

Click Here


Needle sticks and/or other exposures

Hospital employees: Needle sticks and/or other exposures (including blood or body fluids), call the Rapid Response Team at 934-3675.
Campus employees: Employees with needle sticks and/or other exposures should be evaluated at The Workplace (during normal business hours), UAB Urgent Care, UHED or Highland ED.

Transporting Injured Employees

Injured employees should use Blazer Express for transportation to and from The Workplace for the initial visit.  The Workplace is located at UAB Highlands, Suite 100.  Their telephone number is: 205-933-5300.


Contact OJI