Occupational Injury Reporting Process

Upon notification of workplace injury or illness, the immediate supervisor will complete a Risk Management Services (a.k.a., Work Connections) Claims Submission Form.

  1. The first question on the form says: "What type of incident are you reporting?"
  2. The drop menu will have an option for "Employee Injury or Illness", use this option.
  3. The Reporter (i.e., injured employee's immediate supervisor) will complete the Claims Submission form and attach any supporting documents, such as but not limited to; photographs, police report, or Work Connections Injury/Illness Report Form.
  4. Click on the "Summary" button on the bottom of the page. The Reporter will review the Event Details and any Attachments for the claim. Click on "Submit" to send the report.
  5. The completed report is sent directly to Risk Management Services in Ann Arbor. The supervisor will automatically receive a copy of the report via email.
  6. After the form and documents are submitted to Work Connections, the supervisor is required to forward a copy of the completed report to UM-Dearborn Human Resources and the EHS Department for local record-keeping purposes.

If there are any questions regarding this process, please contact the EHS Department at 313-583-6679 or send an email to David Fogle, EHS Director.

Environmental Health and Safety

108 - Auxiliary Program Center
4901 Evergreen Road
Dearborn, MI 48128
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Phone: 313-583-6679
Fax: 313-493-9161