NORTH CAMPUS SECURITY

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

Click on Student Notification of Injury Form to review or print.

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

Click HERE for RISK MANAGEMENT WEBSITE.

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

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

Click First Report of Injury Form to Review or Print

Don't know how to fill out the Employee Injury Form then Click First Report of Injury Instructions to Review or Print

Ensure the completion and submittal of the First Report of Injury form with signatures. Fax immediately to (904) 632-3145) and forward the original as soon as possible to Risk Management.

For more information Click here APM 03-906 to review.

Click First Fill Document 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 HERE for RISK MANAGEMENT WEBSITE.