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![Leg Injury](https://static.wixstatic.com/media/11062b_d75076444824430a818741565ee5d57f~mv2.jpeg/v1/fill/w_863,h_575,al_c,q_85,usm_0.66_1.00_0.01,enc_auto/11062b_d75076444824430a818741565ee5d57f~mv2.jpeg)
Reporting Procedures
EMPLOYEE IS INJURED
If Injury results in death or overnight hospital stay call IPEP immediately at 800-382-8837.
COMPLETE FORMS AND SUBMIT TO IPEP
1. FIRST REPORT OF INJURY (Completed by Employer)
2. SUPERVISOR'S INCIDENT REPORT (Completed by Employer)
3. MEDICAL AUTHORIZATION FORM (Completed by Employee)
fax 765-868-3310
IS TREATMENT REQUIRED?
YES
DIRECT EMPLOYEE TO DESIGNATED OCC HEALTH CLINIC OR ER
CONTACT IPEP FOR ANY REFERRALS
NO
CLAIM IS SET UP AS A RECORD ONLY WITH IPEP
CONTACT IPEP ASAP IF TREATMENT BECOMES NECESSARY
IPEP Reporting Procedures
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