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COVID-19 Contact Form & Instructions for possible Worker’s Comp

When an Employee becomes aware that they have been potentially exposed while in the course of their duties, the process should go something like this:

  • Employee becomes aware that they have been potentially exposed while in the course of their duties.
  • Employee and Supervisor complete the standard Workers’ Compensation packet of forms along with the new contact form. Access DHS COVID-19 Info and Other HR-Related Items which includes the new COVID-19 contact form and instructions.
  • This completed packet will be sent immediately to DHS Risk and Safety Management.
  • Risk and Safety will hold these forms until the employee becomes symptomatic.
  • Workers Compensation Claim will then be submitted to Gallagher Bassett along with the contact form (the form will help us investigate the claim).
  • During the possible incubation period, Risk and Safety will open dialogue with Gallagher Bassett and discuss the facts of the impending claim.

Having the contact form completed early will help to eliminate confusion later as to the employee’s whereabouts during the potential exposure period.

Should you have questions, feel free to reach out to Risk & Safety Management.