Team Member Workplace Injury Reporting

Team Member Checklist

  • Report the injury to your supervisor as soon as possible. Emergent steps may be needed if your injury involves bleeding, unconsciousness, or a serious physical injury to include calling 911 and/or being transported by ambulance to an area hospital.
  • Complete the online Team Member Injury Report with your supervisor.
  • Submit to a urine sample for testing.
  • If the injury is a musculoskeletal injury, your supervisor will work with you to schedule a therapy evaluation at Innovate Physical Therapy. A physician’s order is needed to continue further treatment.

Important Information:

  • If the injury requires medical attention, a Return to Employment Recommendation form will be provided and the medical provider must complete, outlining any restrictions or if cleared to return to work with no restrictions. Please NOTE, you are responsible for providing this form to the medical provider for completion and returning it to your supervisor by the next business day.
  • Per the Nebraska Workers’ Compensation Act, if your workplace injury requires time off from work, the first seven days are considered a waiting period and are not paid unless you have PTO. On the eighth calendar day you are eligible for indemnity payments (wage replacement) from Hillcrest’s insurance carrier.
  • Should you have any questions involving a worker compensation claim, benefits, or anything related to workers compensation, feel free to contact the Hillcrest Director of Compliance, Shane Young, at (402)-682-4165.

Supervisor Checklist

  • Upon learning of the injury, triage the team member to evaluate the severity of the injury. Ensure emergent steps are taken if the team member is bleeding, unconscious, or has a serious physical injury. If team member goes to Concentra, ensure that the visit is authorized by a designated Supervisor.
  • Coordinate a UA test with the team member at our service line or through a medical provider. UA Documentation is required.
  • If the team member fits criteria for Innovate Physical Therapy help facilitate the referral.
  • Complete an online Supervisor Report for Team Member Injury, including root cause analysis.
  • Follow up with the team member to identify any work restrictions or accommodations the team member will need for treatment of the injury.


  • In the event of a team member being hospitalized or a team member’s death, notify Administrator and Director of Compliance asap. Complete Formal Root Cause Analysis.
  • If a team member will be missing any work due to an injury, it is the supervisor’s responsibility to find coverage.