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1

Onsite Assessment and Referral

In the event of a severe injury or if the injured employee or supervisor determines that emergency medical response is needed, please call 911 and/or the Towson University Police Department (TUPD) for immediate assistance and ambulance transportation to St. Joseph鈥檚 Hospital (Emergency Room).

If emergency assistance is not required, the University鈥檚 Insurance Administrator should be contacted to coordinate/facilitate assessment and referral services:

Kim Campion, Insurance Administrator,

(410) 704-6377

 

The injured employee can be referred directly to the University鈥檚 occupational medical provider:

Concentra Medical Center

1830 York Road, Suite F, Timonium, MD 21093

 

Hours of Operation: 

Monday 鈥� Friday: 8 a.m. 鈥� 6 p.m. Saturday: 8 a.m. 鈥� 2 p.m.

 

Phone: 410-252-4015

 

2

 Completion of Injury Report

All work-related injuries must be reported promptly to the Insurance Administrator in the OHR using the following forms:

Employee First Report of Injury: After the incident, the employee should complete, sign and date the form provided as soon as possible. If the employee is physically unable to complete the form, the supervisor can record the details as shared by the employee. If the supervisor must complete the form on behalf of the employee, please note this in the 鈥淎ny Other Relevant Information鈥� section of the form.

3

Supervisor Report of Work-Related Injury 

Supervisor Report of Work-Related Injury. This form must be completed, signed, and dated by a supervisor who was present during the incident or to whom the incident was reported. It does not need to be the direct supervisor if they were not present or involved in the investigation or reporting of the incident.

4

Witness Statement

Witness Statement. Any witnesses to the incident complete, sign and date the form. A witness may include a non-employee. A witness may also be someone who did not witness the incident, but was aware of the circumstances leading up to the event, or was in contact with the employee following the incident.

5

Report Submission

Completed forms should be sent to the OHR Insurance Administrator within 24 hours of the incident. If some statements aren鈥檛 ready in that timeframe, submit the ones you have completed. 

Forms may be faxed to 410-704-6320 or 6321. Forms may also be emailed, via Towson鈥檚 secure file delivery service, to workinjury AT_TOWSON. If photographs or video of the incident are available, please include them with the forms.

6

Next Steps 

Upon receipt of the report, the Office of Human Resources will review, investigate (if necessary), and file the claim with the University鈥檚 Workers Compensation insurance provider. The insurance carrier will then contact the injured employee to gather any additional information and discuss the next steps.