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Human Resources Benefits

Workers’ Compensation


Worker's Compensation Contact

    Tanya Bombicca | tbombicc@bloomu.edu
    134 Waller Administration Building
    (570) 389-4151 | Fax: (570) 389-3700

No one wants to see an accident or injury in the workplace, but sometimes they occur. In the event of an accident or injury at work, it is important that employees fully complete an accident form in a timely manner. This will provide University personnel the ability to identify and correct any related safety issues, to prevent further injuries, and to encourage/expedite prompt medical treatment.

The Office of Human Resources and Labor Relations is committed to assisting all employees with any and/or all aspects of a workplace accident or injury.

Workers’ Compensation Forms

  • Accident/Injury Report — Return to your supervisor or the human resources office
  • Medical Treatment Rights and Responsibility Form
  • Injury Exposure Form
  • Medical Certificate
  • Panel Doctors List (as of 1/27/11)
  • Leave Election Form
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