If an injury occurs during the course of your work for Saint Paul College, you are responsible for
reporting the injury immediately to your supervisor, lead administrator, or Human Resources Office
and completing the “ Information and Privacy Statement” and the “Employee Statement Regarding
Injury/Illness and the Leave Supplement Form”. The forms are available in the Human Resources
Office, or printed from the following websites: www.risk-workerscomp.admin.state.mn.us/forms.htm
If the Employee Statement Regarding Injury/Illness form is turned into a supervisor or lead
administrator, they must immediately notify Human Resources personnel via email or in person, and
promptly submit the Employee Statement Regarding Injury/Illness form to the Human Resources
Office to begin the process of determining eligibility for workers compensation benefits, if the
illness/injury is compensable under Workers’ Compensation. All forms must be returned to
Human Resources within 3 days of the injury.
The Information and Privacy Statement should be given to injured employees prior to obtaining
information from them on the Employee Statement Regarding Injury/Illness. This form is used to
ensure compliance with the Minnesota Government Data Practices Act.
Injured employees should be treated by Saint Paul College’s designated CMC network clinic (check
with Human Resources for current designated clinic) or if they have an established relationship with a
doctor (i.e. seen within the past year) can go to their primary care clinic. If it is an emergency, they
should go directly to Regions Hospital Emergency Room.