Workers’ Compensation Instructions
WHEN AN INJURY OCCURS, NOTIFY THE SUPERVISOR IMMEDIATELY then complete the following steps:
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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. If Angie is out of the office you will be directed to Jason Heinz. DO NOT CALL DIRECT EXTENSIONS NOR LEAVE A VOICEMAIL.
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The employee should take the following forms and information to URGENT CARE in CANTON @ 55 Buckeye Cove Road, Canton, NC 28716 (I-40, exit 31 next to Sagebrush):
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–EMPLOYEE-WORKERS COMP-PROCEDURE-INFORMATION-FOR-WORKERS
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Choose forms for either EMC Insurance or SEDGWICK (determination provided by Angie Ballance):
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EMC Insurance 8/29/2023
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Sedgwick Worker’s Comp Forms 3/10/2021
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School/Location Worker’s Comp designee: fill out the following and fax immediately to Central Office 828.456.2438 or aballance@haywood.k12.nc.us:
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FORM 19 ALL HIGHLIGHTED FIELDS FILLED IN and form signed by principal or location supervisor (if other than a school).
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ACCIDENT.INCIDENT-INVESTIGATION-REPORT signed by principal or location supervisor (if other than a school).
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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 Angie Ballance (ext 2139) at 828.456.2400.
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