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Work Related Injury (Worker's Comp) Forms -
County Department Heads
First Report of Injury Form
The First Report of Injury form should be completed and sent to the County Council office any time an employee sustains a work related injury, regardless of whether he/she seeks medical attention.
First Fill Program Pharmacy Card
In the event your employee needs medical attention, you should also fill out the two-part Medical Authorization form with St. Mary's Occu-Med locations. Those forms are available in the County Council Office. The white copy of that form goes with the employee and the yellow copy should be sent to the County Council office.
If you have any questions, please don't hesitate to call Teri Lukeman, County Council Executive Assistant, at 812-435-5790 or email her at TLukeman@vanderburghgov.org.
You must have Adobe Acrobat Reader to use these forms which are in PDF format. If needed, you can use the link to to left to install Adobe.
Any comments or questions, email a contact.
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