University Human Resources
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.
- Download and print PDF of Occupational Injury/Illness form which includes the Authorization for Medical Records.
- Fax the completed form to IU Workers' Compensation at 812-855-2720 or email to .