The following is a list of definitions to assist you in completing the DRDB. If you still need assistance, please do not hesitate to call the Workers’ Compensation Office at 217-333-1080 or (877) 866-4067.

Report No.: the number of this report (1, 2, 3, etc.).

Final: Should be checked if this is the last report the Workers’ Compensation Office will receive from the department.

Employee: the name of the injured employee.

Date: the date the DRDB is completed.

Department: the department where the injured employee is employed at the time of injury.

Regular Scheduled Work Days: the days the injured employee is scheduled to work.

Hours Worked Per Day: the number of hours the injured employee is scheduled to work each day.

Injured on: the date the employee was injured.

Returned to work on: the date the injured employee returned to work.

First day of absence (Excluding Date of Injury): the first full scheduled work day lost from work (the day of the accident is NOT included).

Number of work days missed (Excluding First Day of Absence): the number of work days the injured employee lost for the reported pay period.

Number of workdays missed paid with employee benefits: the number of work days paid by the injured employee’s department for the reported pay period, starting with the first day of absence.

Amount paid with benefits: the amount the injured employee was paid by the department for the number of work days missed since the first day of absence for the reported pay period.

Number of work days missed unpaid with employee benefits: the number of work days unpaid by the injured employee’s department for the reported pay period.

Amount unpaid: the amount the injured employee would have been paid for the unpaid days for the reported pay period.

Hourly rate of pay at time of injury: the hourly rate of pay the injured employee is/was receiving at the time of the injury.

Average weekly earnings at time of injury: the amount of weekly earnings the injured employee earned at the time of the injury.

The above information covers the pay period beginning and ending: the pay period, following the University payroll schedule, for which the injured employee is being paid for time lost from work.

Attach a copy of the daily time report for the above pay period: department is required to attach a copy of the injured employee’s daily time report for the reported pay period.

Date: the date the DRDB was completed by department.

Department Head or Assignee: to be signed by the department head or an authorized signer for the department head.

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