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Report of Accident/Illness Form

  • Employee accidents: immediate Supervisor completes this form immediately.
  • Non-employee accidents: OSU employee notified of injury completes this form.
  • Print a copy of the completed form for your department records. Next, click the “Submit” button at the bottom of the completed form to submit to the Office of Human Resources (please note, should be completed and submitted within 24 hours of Accident).
  • A downloadable version of the form is also available. 
    • Download the file
    • Click the “Submit by Email” box at the bottom of the completed form to submit to the Office of Human Resources (please note, should be completed and submitted within 24 hours of Accident). Next, print a copy of the completed form for your department records.
    • NOTE: Mac users: When using the downloadable form, please print and scan the form to submit to the Office of Human Resources, as this form cannot be submitted by email via Mac

 

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to be completed for all reports

Below section for employee accidents only, not required for non-employee reports. Please provide additional employee information below.

NOTE: if medical attention sought for employee’s job related injury, SAIF 801 form required within 24 hours

Employee Benefits Staff List

Employee Benefits - 204 Kerr | 541-737-2805 | general email
Donna Chastain Donna Chastain Employee Benefits Manager 541-737-2806
Heidi Melton Human Resources Officer
Workers’ Compensation, Standard Insurance Claims (STD&LTD)		 541-737-2916
Christina Bacchi Benefits Consultant
Benefit Issues for Business Centers: HSBC, BEBC & AABC		 541-737-2835
Jessica Dalziel Benefits Consultant
Benefit Issues for Business Centers: UABC, FOBC & Chancellor’s Office		 541-737-3521
Roshni Sabedra Benefits Consultant
FMLA/OFLA/Military Leave		 541-737-5946
Whitney Barstad Benefits Consultant
Benefit Issues for Business Centers: ASBC & AMBC		 541-737-2269
Patricia Young Benefits Consultant
Retirement, Savings & Pension Programs		 541-737-8254

Contact Info

Office of Human Resources,
Oregon State University,
122 Kerr Administration Building,
Corvallis, OR 97331-2132
Phone: 541-737-3103
Fax: 541-737-7771 or 541-737-0553.
E-mail
A division of Finance & Administration.
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