3 Table of Contents Page NSU Florida Guidelines - Section A Employer Responsibilities during a Non-Emergency…………….. ........................................ 4 Steps for an Emergency.......................................................................................................4 Dos & Don’ts of Reporting a Claim …………….. ..................................................................5 Departmental Information - Section B Risk Management Department Contact List ......................................................................6 Procedural Information & Injury Report Forms - Section C Nova Southeastern University Procedure Manual (Managers/OHR contacts) ....................................................................................................7 List of Medical Treatment Locations ..................................................................................... 8-9 First Report of Injury Form ............................................................................................... 10-11 NSU Employee Statement Regarding Cause of Accident ......................................................... 12 CCMSI/NSU Workers’ Compensation Treatment Authorization Form................................13 CCMSI Authorization for Medical Records and Communication Release .................................... 14 CCMSI False and Fraudulent Claim Warning ..................................................................15 CCMSI MyMatrixx Temporary Prescription ID card (English) .................................................... 16 NSU Workers’ Compensation Witness Report form ................................................................. 17 Employee Information – Section D NSU Workers’ Compensation Quick Facts ........................................................................ 18-20 I Am Injured Now What ................................................................................................... 21-24 69L-3.0036, F.A.C. Employer Informational Brochure ......................................................... 25-28 Resources ........................................................................................................................................ 29
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