Student Accident Reporting Form

Instructions

Do not refuse medical care because of the cost. The College has resources to help cover the cost of medical care due to injuries. Medical expenses for a student injury while working at Smith are reimbursable through worker’s compensation. Students not covered by worker’s compensation can also seek financial assistance by applying for emergency funds through the Dean of the College.

Students who are injured during college-related activities, but not while employed by the college are not eligible for worker’s compensation. The College wants to know about student injuries, so the College’s Safety Committee asks all students who are injured on campus or during College-related activities, but are not employed by the college or engaged in an activity for which they are employed by the college, to complete the accident reporting form at the bottom of this page. This includes part-time students, students in summer (excluding SURF) or special programs, and students from other colleges who are taking courses, conducting research, or participating in a Smith College activity should also complete this form.

Students are considered an employee of Smith College if they are paid in any way by the college. Any medical expenses due to work-related injuries are covered by the College’s worker’s compensation plan. If a student is injured while engaged in the activities they are paid to do, students should contact their supervisor and print and complete the “Report of Job-Related Accident” form as soon as possible, (receiving medical care is the first priority). Student employee positions include but are not limited to, graduate students, students participating in SURF (regardless of hourly or stipend pay), working as teaching assistants, research assistants, graders, QuickAdmins, office assistants, event assistants, and tutors. Please state to any healthcare provider that this treatment is covered by Smith College worker’s compensation. The job-related accident report, receipts for reimbursement (including copays), invoices/bills for treatment, and questions regarding a worker’s compensation claim should be directed to Human Resources, Amy Smith, asmith13@smith.edu, 413-585-2289.

When you have completed the upper section of the job-related accident form, please give it to the supervising faculty or staff member for their comments. This form should be completed within 24 hours after the accident—it is most helpful when received then– but will be accepted after that time. Completed forms should be scanned and sent to Amy Smith asmith13@smith.edu, cc’ing hr@smith.edu and mrakas@smith.edu.

The Schacht Center maintains lists of local health resources including nearby clinics.