On-the-job injury/illness is an event not to be taken lightly by either employees
or supervisors. If you experience an OTJ injury/illness, you must report it! Questions regarding worker compensation may be directed to the WVU HR Medical Management Unit staff at (304) 293-5700 x8 or via e-mail: medicalmanagement@mail.wvu.edu.
1) Filing deadline within 24 hours of injury
2) Employee and Supervisor must sign this form
3) Send completed forms for processing to:
B. Employee Option to file WC-1 FormOriginal:
WVU Office of Environmental Health and Safety PO Box 6551 Morgantown WV 26506-6551 Copy:
WVU Human Resources Medical Management Unit PO Box 6640 Morgantown WV 26506-6640
1) Six months from injury date to file
a) If not filing, signed statement required
b) If filing, send completed form to:
WVU Human Resources
Medical Management Unit
PO Box 6640
Morgantown WV 26506-664
C. Witness Statement required if injury was witnessed
D. Return
to Work Notice
1) Required if employee off work longer than 3 days
E. Option Election Notice - completed after consultation with Medical Management staff
F. Release Form - authorizes review of medical records related to the injury/illness
