FSCJ NORTH CAMPUS SECURITY (904) 766-6608

The NOI form must be completed when a student is injured in a classroom or lab setting.

Part "A" is completed and signed by the injured student.
Part "B" is completed and signed by an auhtorized Instructor or Administrator.

NOTE: You will need to contact Security at (904) 766-6608 to initiate a Student Injury report.

FAX the completed Student NOI form form to Risk Management.
Risk Management FAX number is (904) 632-3145

Reminder: It is the student and instructor's responsibility to notify Security to initiate an Incident Report of the injury.

Click Download file to review or print.

This form must be completed by the supervisor when an employee is injured.

The completed form will need to be sent by FAX to Risk Management.
Risk Management FAX number is (904) 632-3145

Reminder: It is the employee and supervisors responsibility to notify Security to initiate an Incident Report of the injury.

Click First Report of Injury Form to Review or Print

This form has been authorized for workers' compensation prescriptions from authorized workers’ compensation physicians. There are over 55,000 (nine out of ten) pharmacies in the national network. You may use your local pharmacy, call the toll free number for a list of other convenient pharmacies in your area, or go to www.cypresscare.com and use the pharmacy locator.

If you have any questions about the usage of this form or would like to discuss having your work-injury medications conveniently sent directly to your home, please call the toll-free customer service number: 1-800-419-7191 between the hours of 8:00am - 8:00pm EST.

Click First Fill Document form to Review or Print