WORKERS’ COMP/SAFETY

Workers’ Compensation Instructions

WHEN AN INJURY OCCURS, NOTIFY THE SUPERVISOR IMMEDIATELY then complete the following steps:

Call the Central Office 828.456.2400 directly and advise receptionist it is a Worker’s Comp call. You will be directed to Angie Ballance or DJ Kerby. DO NOT CALL DIRECT EXTENSIONS NOT LEAVE A VOICEMAIL.
The employee should take the following forms and information to URGENT CARE in CANTON @ 55 Buckeye Cover Road, Canton, NC 28716 (I-40, exit 31):
- Employee Procedure Information for Workers Comp
- Choose forms for either EMC Insurance or SEDGWICK (determination provided by Sarah Markley):
  - EMC Insurance 8/29/2023
  - Sedgwick Worker’s Comp Forms 3/10/2021
School/Location Worker’s Comp designee: fill out the following and fax immediately to Central Office 828.456.2438 or smarkley@haywood.k12.nc.us:
- Form 19 – All highlighted fields filled in and form signed by principal or location supervisor (if other than a school).
- Accident Incident Investigation Report signed by principal or location supervisor (if other than a school).
- Signed and dated Witness Statement *If principal or location supervisor is not available, submit UNSIGNED forms via fax and send SIGNED forms via Pony Mail.

If you have concerns, questions or doubts about the employee’s injury, please contact Sarah Markley (ext 2111) at 828.456.2400.

IF AFTER HOURS, CONTACT DJ KERBY FOR INSTRUCTIONS.