Employee Workplace Injury Procedures

  • If the nurse is present, go to nurse’s office for evaluation and paperwork.
  • If the nurse is not present report to building secretary.  The nurse or secretary will be your “Name of Contact” located on the First Report of Injury.
  • 2nd and 3rd shift employees (after hours) please call Susan Stiffney, RN, @ 574-238-4325.

Employee must complete “First Report of Employee Injury* within 24 hours and send it to Central Office via fax 533-2505 and pony the original to Central Office.

    • If it is determined the employee does not need further evaluation at this time, the First Report of Worker Injury will be completed by the employee and sent to Central Office via the pony for filing.
    • If it is determined the employee needs to go for further medical attention she/he is to report to Community Occupational Medicine (COM)** for treatment.  You need authorization for this. Please call Central Office as they will need to call COM for treatment authorization. (if not available, please call Susan Stiffney@ 574-238-4325)
      • copies of all medical paperwork are to be sent to Central Office
      • follow-up appointments should be arranged during non-working hours – missed work is to be marked sick time or loss of pay
      • continue with the treatment schedule until you have been “released” by the physician (failure to report for appointments may result in termination of the claim by worker’s compensation insurance)
      • all treatment expenses of worker’s compensation injuries will be paid by United Heartland
      • if medication is prescribed, tell the pharmacist this is a work related injury – the pharmacy will bill United Heartland direct

You are free to seek medical care from your personal physician; however, it will not be considered Worker’s Compensation and will be billed to your personal insurance carrier.

Call  anytime after business hours:

Susan Stiffney, RN
(574)  238-4325 (cell)

*Please print the First Report of Employee Injury form, complete and return to the Central Office.

**Community Occupational Medicine
2312 Eisenhower Drive N
Goshen, IN  46526
Ph. (574) 534-1231
Fx. (574) 534-8186

Community Occupational Medicine

2312 Eisenhower Drive N

Goshen, IN  46526

Ph. (574) 534-1231

Fx. (574) 534-8186