Soldier Statue with building behind

Forms

Note: Rogers State University is Agency #461.

Procedures

In the event of a workplace injury, the first priority is to seek medical treatment for the injured employee, if needed. All incidents must be reported to the Office of Human Resources as soon as possible.

Emergencies:

  • If the injury is life threatening, call 911 for emergency medical treatment.
  • Steps 3-6 below should be followed as soon as reasonably possible.

Non-emergencies:

For non-emergency injuries, the following steps should be followed:

  • Step 1: Employee should notify his or her supervisor as soon as the injury occurs (prior to seeking medical treatment).
  • Step 2: Supervisor will refer injured employee to the Student Health Center. Should the injury require additional medical attention or occur outside normal office hours, the employee will be referred to one of the Participating Providers below:
    • Claremore:
      Access Medical Center Blue Starr // 918-343-6000
      401 W Blue Starr Dr., Claremore, OK  74017-4006
      Ascension St. John Urgent Care Claremore // 918-343-6855
      1910 South Falcon Ave., Claremore, OK  74019
    • Bartlesville:
      Access Medical Center // 918-331-9184
      2334 SE Washington Blvd, Ste B, Bartlesville, OK 74006
    • Pryor:
      Access Urgent Care // 918-825-7555
      4111 Redden, Pryor, OK  74361
  • Step 3: Employee must complete the Authorization for Release Form (doc) and return it to the Human Resources Office. 
  • Step 4: Employee should take the Return To Work Form (docx) to the provider. Employee will be required to return the completed form upon his or her return to work.
  • Step 5: Employee should follow the instructions on the First Script Form (pdf) to fill related prescriptions at no cost.
  • Step 6: Supervisor will complete the Incident Investigation Report (pdf) and return to Human Resources within 24 hours of the incident. Prompt reporting of the injury is imperative to ensure the employee receives proper approval for treatment.