Forms: Accidents and Injuries

Accident/Injury Report Form

Employees, students and visitors to Western Michigan University may access this form via an online Accident Injury Report (311 form) which includes a link to the form and related instructions. The the Accident Injury Report (311 form) must be completed for all work-related injuries, no matter how serious.

Physical Capabilities Form

Please use the online Accident / Injury / Incident Report (311 Form) to report all incidents, injuries and illnesses.

Report of Claimed Occupational Injury or Illness

Print the WC210 form and have injured employee bring to Bronson ProHealth Services located at 820 John Street, Suite 102, Kalamazoo MI 49001. If you are having a medical emergency call 911 or proceed to the emergency room.

Report of claimed occupational injury or illness (WC210)

Workers Compensation Sick Leave Designation Form (AFSCME)

For use by AFSCME employees. Please complete the sick leave designation form to utilize accumulated sick leave to supplement workers' compensation benefits.