WORKERS'S COMPENSATION PROCESS

							                WORKERS’S COMPENSATION PROCESS



                            INJURED
                          EMPLOYEES?




                              YES



                          EMPLOYEE OR
                           SUPERVISOR            FORMS AVAILABLE
                         COMPLETE “FIRST         FOR EACH DIVISION
DAS/CCM
                        REPORT OF INJURY”
EMPLOYEES ONLY:
                              FORM
SUBMIT COMPLETED
FORM TO CINDY
HOULSON, 515-281-
0181 OR E-MAIL:
CYNTHIA.HOULSON
@IOWA.GOV               SUBMIT
                        COMPLETED FORM
                        TO COLLEEN
                        JONES, 515-281-6773
                        OR E-MAIL:
                        COLLEEN.JONES@
                        IOWA.GOV




                        COLLEEN WILL FAX          COLLEEN PROVIDES
                        SEDGWICK (IOWA’S          INPUT TO OSHA 300
                        WORKER’S COMP             AND INPUT TO OSHA
                        PROVIDER)                 300A POSTED LOG