On-The-Job Injury/Illness Program

Mailing Address
OJI Program, AB 215
1720 2nd Ave. S
Birmingham, AL 35294
  Physical Address
Administration Building
701 20th Street South | Room 215
Birmingham, AL 35294
  Email: HRrelations@uab.edu
Phone: 205-934-4458
Fax: 205-934-1407


OJI Contacts

Anita Bonasera, SPHR Executive Director | HR bonasera@uab.edu
Monica Jones HRM Specialist mjones9@uab.edu
Brentwood Services Administrators



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. Adobe© Reader is free from adobe.com — click on the icon to download.


  • 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
    Do not use this form if you have access to Trend Tracker, the electronic incident reporting system. If you do not have access to Trend Tracker, the paper incident report form must be completed by employee and signed by the supervisor to be forwarded directly to: 
    Monica Jones | AB 215
    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.

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, both available on the Instructions and Forms for OJI page. The Trend Tracker Incident Report must also be completed before any bills will be paid:



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 205-934-3675.
  • Campus Employees (to include Post Doc, graduate student employees, visiting scholars and visiting scientists): Employees with needle sticks and/or other exposures should be evaluated at The Workplace during the work week (Monday-Friday, 7 a.m. to 4 p.m.). If an incident occurs on the weekend or outside The Workplace’s hours of operation (7 a.m. to 4 p.m.), employees should go to UAB Highland’s ED or University Hospital 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. The phone number is 205-933-5300.

Instructions and Forms for OJI

The Instructions and Forms for OJI page provides detailed instructions for employees and supervisors, and downloadable forms necessary to handle an OJI incident. Please review all forms and instructions carefully. 

Contact OJI