University of Missouri Form UM WC-1 2016-2025 free printable template

882. 7861 or email to umrimwcclaims umsystem.edu EMPLOYEE INFORMATION Date of Incident Employee Number Campus Columbia Kansas City Name last first middle initial Rolla St. Louis UM System Hospital Department/Title Home Address Phone Number Supervisor s Name Supervisor s Phone Number Injury Time Time Work Began Last Paid Work Day ACCIDENT INFORMATION Date University Notified Salary Continued Yes Date Returned to Work Number of Days Worked/Week No Incident Type burn foreign body sprain fracture...

How to fill out umwc1 report injury form

How to fill out University of Missouri Form UM WC-1

1. Obtain the University of Missouri Form UM WC-1 from the university's website or administrative office.
2. Read the instructions carefully to understand the purpose of the form.
3. Fill out the personal information section, including your full name, student ID, and contact information.
4. Provide detailed information regarding the incident or issue that prompted the need for the form.
5. Attach any required documentation or evidence to support your submission.
6. Review the completed form for accuracy and completeness.
7. Sign and date the form where indicated.
8. Submit the form to the appropriate department or office as outlined in the instructions.

Who needs University of Missouri Form UM WC-1?

1. Students seeking to report an incident or request assistance related to university policies.
2. Individuals who need to document issues affecting their academic experience.
3. Personnel handling administrative matters that require formal reporting.

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What is University of Missouri Form UM WC-1?

The University of Missouri Form UM WC-1 is a specific form used for reporting workers' compensation claims or related information within the University of Missouri system.

Who is required to file University of Missouri Form UM WC-1?

Any employee or department within the University of Missouri that experiences a workplace injury or incident requiring workers' compensation benefits must file the UM WC-1 form.

How to fill out University of Missouri Form UM WC-1?

To fill out the University of Missouri Form UM WC-1, provide details about the injured employee, the nature of the injury, the date and location of the incident, and any medical treatments received.

What is the purpose of University of Missouri Form UM WC-1?

The purpose of the University of Missouri Form UM WC-1 is to formally document workplace injuries and to initiate the workers' compensation claims process.

What information must be reported on University of Missouri Form UM WC-1?

The form must report the injured employee's name, department, date of the injury, a description of the injury, incident details, and any medical treatment provided.