Warning: session_start(): Cannot send session cookie - headers already sent by (output started at /home/www/www/html-root/hr/workcomp/index.php:2) in /home/www/www/html-root/hr/workcomp/workcomp.php on line 6

Warning: session_start(): Cannot send session cache limiter - headers already sent (output started at /home/www/www/html-root/hr/workcomp/index.php:2) in /home/www/www/html-root/hr/workcomp/workcomp.php on line 6
First Report of Injury – Minnesota State University, Mankato
shortcut to content
Minnesota State University, Mankato
Minnesota State University, Mankato

First Report of Injury

Page address: https://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

*
Employee
Student Worker

*

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

*

*

*

*


*
Part-Time Full-Time

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


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM


AM
PM

*

*

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

* (Optional)

Incident Data

* (mm/dd/yy)

*

AM
PM

* (mm/dd/yy)

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

*

*

*

*





Student Worker Data

ONLY COMPLETE THIS SECTION FOR STUDENT WORKERS

*

*

*

*