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Workers’ Compensation
Use the following forms to report incidents, accidents and injuries. For help or questions relating to workers’ compensation claims, please contact Human Resources at benefits@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
Resources
Fire Employees

Submit all documents and completed forms to Human Resources/Workers’ Compensation 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.