Injury Forms

All employees should be familiar with the steps necessary to seek treatment for injuries occurring at work. Our procedure is listed below:


  • Employee reports accident to supervisor or designated office staff immediately.
  • If injury is severe, call 911 or transport employee to Sturgis Hospital E.R. ASAP and Contact Tracy Stevens.
  • If injury is not urgent, call Dr. Amaria’s office to schedule the appointment and take the signed Authorization to treat form with you. Employee MUST take signed form with them to the appointment.
  • A DETAILED Employee’s Report of Injury is filled out ASAP.
  • Supervisor immediately emails/faxes the employee report and supervisors report forms to Tracy Stevens within 24 hours.
  • After visit, employee should provide a doctor’s note with diagnosis and activity report to their supervisor.
  • Sturgis Hospital and/or Dr. Amaria’s office will work with our workers compensation claim representative to ensure quality of care and approve future visits and prescribed treatments, including physical therapy, diagnostic tests and specialist referrals. (Initial Authorization to Treat is only for the initial treatment)
  • Tracy Stevens will work with employee’s supervisor on restricted work options. 

Per legislation, all injured employees with a workers’ compensation claim are required to seek treatment by the district-approved medical provider for the first 28 days of medical care. After the 28 days, you may seek medical treatment from your own physician (pending they are an approved BCBS provider).