Workers' Compensation - City of Springfield Oregon

Workers’ Compensation

Use the following forms to report incidents, accidents and injuries. For help or questions relating to workers’ compensation claims, please contact Risk Management at Risk@springfield-or.gov.

Forms
Incident Analysis Form (IAF) – Complete this form anytime there is an incident or near miss. Supplemental Medical Form – Complete if there is any type of medical treatment including self-administered first aid, ER/doctor’s visit, hospitalization, etc. 801 SAIF Form – Complete for filing workers’ compensation claim when seeking medical treatment. Work Status Report – Have medical provider complete when seeking treatment. Bloodborne Pathogen Exposure – Complete if there’s exposure to blood or contagious disease. Contact the Risk Manager within 24 hours of exposure.
Packaged Forms
Incident Only Incident with First Aid Only Incident with Medical Treatment Incident with Bloodborne Pathogen Exposure
Resources
City of Springfield WC Guide – A guide to how WC is processed and answers to most asked questions What Happens if I’m Hurt on the Job? – A guide to Oregon’s workers’ compensation benefits, rights, and responsibilities. Worker Journey Infographic – A flowchart of the workers’ compensation process.
Fire Employees
Complete the Safety Incident Report (SIR) for an incident. Include an 801 if seeking medical attention.

Submit all documents and completed forms to Human Resources/Risk Management within five (5) calendar days of the incident. If there is overnight hospitalization or a fatality, contact the Risk Manager immediately at 541-726-3724. Call Springfield Police Dispatch at 541-726-3714 to be connected after hours.

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