Get Workconnections University Of Michigan - Workconnections Umich

Filling out the WorkConnections University Of Michigan form is essential for reporting illness or injury related to work or non-work situations. This guide provides clear and detailed instructions to help users navigate the form effectively.

Follow the steps to complete the WorkConnections form online.

1. Click ‘Get Form’ button to acquire the document and open it for editing.
2. Begin by filling out the faculty or staff member information section. Include your name (last, first, middle initial), today's date, home street address, EMPL ID number, city, state, zip code, social security number, date of birth, home phone number, and work phone number.
3. Provide your department name, department code, occupation, supervisor's name (printed), and supervisor's phone number. Indicate whether the person was out of work due to the illness or injury, and if so, provide the dates.
4. Complete the injury/illness information section, only if applicable to work-related incidents. Include when the incident occurred or the illness began, time, date, name of witness and their phone number, and to whom it was reported.
5. Describe the specific location of the incident, whether it involved a motor vehicle, the nature of the injury or illness, and the part of the body directly affected.
6. Explain the events that caused the injury or illness, and name the object or substance that directly caused the injury.
7. Select the treating facility, and briefly describe the treatment received. Make sure to indicate whether treatment was declined.
8. Ensure all sections are accurately filled and needed details are provided to prevent any delays in processing your report.
9. Once completed, review the entire form again for any missing information, then save changes, download, or print the document, and proceed to submit it as instructed.

Complete your WorkConnections form online today to ensure timely processing of your illness or injury report.