University of Wisconsin–Milwaukee

Workers' Compensation Program
For Managers and Personnel Reps

Information:
Worker's Compensation Lost Time Fact SheetThis provides information for when a work related injury or illness results in absence an employee's absence from work.

Early Return to Work Policy & ProceduresUWM will make every effort to help employees to maximize their healing and facilitate their early return to work.

Safety & Loss Prevention Medical Only Fact SheetThis Fact Sheet briefly explains options available under the Wisconsin Worker's Compensation Act.

Forms for managers:
Employer's First Report of Injury or Disease - DWD FormA supervisor must complete this Department of Workforce Development form within 24 hours of an employee's injury and submit to the Worker's Compensation Coordinator in the Human Resources Office. Although by practice we require the employee to complete the Employee's Work Injury and Illness Report, by Stature it is the employer's responsibility to report and file the WKC-12, First Report of Injury. Do not wait for the employee to complete their report before you complete the WCK-12.

Supervisor's Accident analysis and Prevention Report - UW System FormUW System report that a supervisor must complete and submit within 24 hours of an employee's injury.

Forms for employee:
Employee's Work Injury and Illness ReportEmployees must complete and submit this form within 24 hours of an employee's injury to the Worker's Compensation Coordinator in the Human Resources Office for any on-the-job injury whether it results in loss of work time or not.

Authorization for Release of Medical InformationFor employee injuries resulting in loss of work time, this form should be completed, signed and dated by the employee.

For Limited Term Employees (LTEs) and student employees who have filed a work related injury:
Labor Market Availability Restriction StatementComplete this form and submit it to the Workers' Compensation Coordinator in the Human Resources Office.

UWM Worker's Compensation Coordinator:Barb Willkomm
Phone: 414/229-5652
Email: willkomm@uwm.edu
Human Resources
Engelmann Hall, Room 125