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Reporting Forms
An employee who is injured on the job must inform the employer promptly. Any delay in notifying the employer can delay the payment of benefits. A delay of more than 45 days may result in the loss of all benefits. Notice to a fellow worker who is not a supervisor or otherwise a part of management is not considered notice to the employer.
As soon as possible after an on-the-job accident occurs, an employee must complete a University of Illinois Employee's Injury Report. Employees should fill out the accident report form as completely as possible, sign the form at the bottom and give the form to their supervisor to complete and sign. The forms for the appropriate campus may be found below:
UIC
Employee's Injury Report (PDF)
UIC-Rockford
Employee's Injury Report (PDF)
UIS Employee's
Injury Report (PDF)
UIUC Employee's
Injury Report (PDF)
Employees who have lost time from work in order to recover from the injury or disease may be entitled to receive temporary total disability benefits until they are able to return to work.
A Department Report on Disability Benefits (DRDB) must be completed by the injured employee's department and submitted to the Office of Claims Management/Workers' Compensation Office bi-weekly when an employee has lost time from work due to an on-the-job accident.
The Department Report on Disability Benefits (DRDB) is used to submit time loss to the Workers’ Compensation Office when an employee suffers an on-the-job injury. This form must be sent by the injured employee’s department to the Workers’ Compensation Office in order for the employee to receive his/her Temporary Total Disability (TTD) pay. If the report is not received on time, the employee’s benefits may be delayed. It is recommended that the DRDB be completed and sent to the Workers’ Compensation Office at the same time regular payroll for other employees is being processed since TTD is paid on the same payroll schedule. All time missed from work due to an on-the-job injury should be reported to the Workers’ Compensation Office. The employee’s benefits (vacation/sick leave) should not be used to cover this time loss after he/she has missed the first three scheduled work days. Vacation/sick leave should be used to cover the first three scheduled work days missed.
Instructions for filling out a DRDB form.
DRDB (PDF)