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First Report of Injury – Minnesota State University, Mankato
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Minnesota State University, Mankato

Minnesota State University, Mankato

First Report of Injury

Page address: http://www.mnsu.edu/hr/workcomp/

Supervisors must complete the following information and click the "Submit" button at the bottom of this page.
The screen will display a confirmation message upon successful submission!

Person Data

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Employee
Student Worker

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Employee - Enter the State of Minnesota Employee ID (a.k.a. SEMA4 ID, or Payroll ID)
Student Worker - Enter the Student Tech ID (Listed on Mavcard)

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Part-Time Full-Time

Select ALL applicable days and enter the applicable start and end times!


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AM
PM

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PM


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* (A copy of the report will be sent to the email entered below.)

* (Optional)

Incident Data

* (mm/dd/yy)

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AM
PM

* (mm/dd/yy)

* (South side of..., Building, Room, etc.)

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Student Worker Data

ONLY COMPLETE THIS SECTION FOR STUDENT WORKERS

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