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Indiana University

University Human Resources

Home > Workers' Comp > Occupational Injury/Illness Form

Occupational Injury/Illness Form

Requirement for all campuses

This form contains employee health information and must be used in a manner that protects the confidentiality of the employee to the extent possible while the information is being used for occupational safety and health purposes.



Page updated: 5 November 2014
Contact: • 812-855-4847

Indiana University is an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without
regard to race, color, ethnicity, religion, age, sex, sexual orientation or identity, national origin, disability status, or protected veteran status.
This institution is also a provider of ADA services.