Injury Report Procedures

Compliance with state regulations and insurance guidelines mandates our district to retain appropriate documentation on file when certain incidents or injuries occur.   Please use the forms and instructions below for all injuries.  Review of injury reports helps the district to identify safety issues, L&I  or other potential claim issues.  If necessary, changes can be implemented to help prevent other injuries from occurring.
 
Documentation
Timely reporting prevents the loss of important facts relating to the incident.  
  • Forms must be completed by a staff member. 
  • Documentation may become a legal document in a court of law or part of a public records request.
  • Injury and Incident Reports are for documenting facts only.  Avoid opinions or speculation.

Injury Report Form (IK12 online submission) - form may be printed if prefered

 

Employee Injuries

The district is self-insured for work related injuries. All incidents should be reported immediately to your school nurse (or supervisor, if not at a school site) and to the Benefits Office as the Department of Labor and Industry has strict guidelines that must be adhered to.

Send Staff Injury Reports To:
Human Resources Department
Nidhie Mahajan
425-408-7612
nmahajan@nsd.org
 

Student & Non-Employee

All incidents should be reported immediately to your school nurse (or supervisor, if not a school site).  Injury Reports involving students and non-employees are sent to the Risk Management Department. 

Send Student and Visitor Injury Reports To:
Risk Management Department
Christine Cash
425-408-7630
ccash@nsd.org