There are now three ways to report a Worker’s Compensation injury or illness claim. The County’s
Web Report tool is the fastest and most secure way to report a claim.
Web Report presents several advantages to the injured worker and to a supervisor including:
If you don’t want to use the Web Report, the old paper forms will still be available until they are gone. You can also complete
Form 122 (304 KB PDF).
Please contact Jeff Rowley with questions or problems using
Web Report. Jeff can be reached at
firstname.lastname@example.org or (385) 468-7784.
1. If an employee dies or incurs a disabling, serious, or
significant injury or disease:
a. The administrator, supervisor or designee must immediately
contact the Risk Manager.
b. The Risk Manager must contact the Occupational Safety and
Health Division (UOSH) of the Utah Labor Commission within eight hours of the
occurrence. The Risk Manager will document the name of the person contacted at
UOSH, the date, and time of the contact.
If the administrator, supervisor or designee is unable to
actually communicate with the Risk Manager, they must report the injury to UOSH
within 8 hours of the occurrence and document the contact as noted in b. above.
d. Both the Risk Manager and the administrator, supervisor or
designee must notify the District Attorney of the date and time the death or
disabling, serious or significant injury or disease was reported and provide
the name of the person contacted.
2. The Accident Scene must remain untouched where possible.
Do not remove or alter any tools, equipment, materials or other evidence that
might pertain to the cause of the accident until authorized by the Labor
Commission or one of its Compliance Officers. If the scene can’t be preserved,
note the reason and take many photos of the scene from different angles and
distances and provide the photos to Risk Management.