On the Job Injuries (OJI)

All employees are directed to report all on-the-job injuries immediately to their supervisor. Supervisors and injured employees should complete the following forms:

1st Report of Injury-If treatment is sought, the prescription and treatment authorization forms must be completed.
Treatment Auth & Rx Form-Please complete these forms only if treatment is sought.

OJI Filing Claims Protocol

Once all forms are completed, they should be emailed to Risk Management at wilkes_b@hcde.org     
Supervisors should then send the employee to a treatment facility with the Treatment Authorization form (TAF).
Supervisor should telephone information in to Risk Management at (423) 498-7084 or x20069
Treatment facility or emergency room will provide employee with a Return to Work Authorization form.
Supervisor should email this to Risk Management at wilkes_b@hcde.org.


  • LIFE THREATENING EMERGENCIES: If an injury is life threatening, call 9-1-1 and have employee transported to nearest emergency room.
  • TIMELY NOTIFICATION: In order to properly direct treatment for all OJI injuries, please see that Risk Management receives written notification of employee injury within 24 hours of the incident.
  • COVERED TREATMENT: Supervisors must tell employee not to use HMO or PPO Medical Insurance Card for On-the-Job Injuries or OJI prescription medications.
  • AFTER-HOURS INJURIES: If an employee work injury occurs on weekdays before 8:00 am or after 4:00 pm or on weekends, the employee should be sent (with completed treatment authorization form and HSI Rx form) to the nearest hospital emergency room.

Supervisor will email forms to Risk Managementwilkes_b@hcde.org, Fax to Collins & Company (423) 267-0978, and leave Risk Management (423) 498-7084 a voice-mail message describing the injury details