If you are injured on the job, it is very important that these instructions be followed to ensure that compensation and medical benefits are not delayed.

All on‑the‑job injuries are to be reported the day of the incident. Injuries are to be reported to your supervisor. Accident reports and packets are available in the office of your assigned work location.

If your injury does not require a doctor’s visit, complete the “Employee Accident Report and Investigation Report” (white, 2‑ply form) and give it to your supervisor. Do not complete or submit any other forms. If, at a later date, you need to see a doctor as a result of this injury, then complete the steps below.

BEFORE going to the doctor for treatment (unless the injury requires emergency room treatment), complete the EMPLOYEE section of the enclosed yellow “Self‑lnsured Accident Report” (SIF‑2). Be sure to complete every applicable field and sign both employee signature lines (mid­page, right‑side “Worker Signature”) and leave the employer section blank. Send all copies to Human Resources for processing. Your copy will be returned to you once the claim has been received by HR. Do not take this form to the doctor.

All copies of all documents are to be returned to Bellevue School District, Human Resources.

Employee should not perform work beyond the capabilities recommended by the physician.

Employee may seek medical care from any provider who is qualified to treat the injury. Employee should tell the provider that they are an employee of the Bellevue School District, and that they are calling on a work‑related injury when they phone to schedule the medical appointment.

The following medical facilities specialize in occupational injuries and do not require an advance appointment, but do request a phone call prior to visit:

US Healthworks
1925 – 140th Avenue NE
Bellevue, WA  98005
(425) 865-8060
Clinic Hours: 7 am – 7 pm M-F; 9 am – 5 pm Sat.

Immediate Clinic
15600 NE 8th Street #A-4
Bellevue, WA 98008
(425) 643-3331
Clinic Hours: 8 am – 8 pm Daily

Group Health Eastside Hospital
Urgent Care-Emergency Room
11511 N.E. 10th Street
Bellevue, WA 98004
(425) 502-4120
Occupational Health Clinic: (425) 502-3670

Please contact the Human Resources/Benefits Office at (425) 456‑4080 if you have questions.

Claims Administrator

Sedgwick CMS
220 West Mercer St. #300
Seattle, WA  98119
(800) 579-1260 or (206) 262-4400