Royal School District

A Tradition of Pride and Excellence

Royal School District is "self-insured" for our Workers Compensation Program through the Educational Service District No. 105 in Yakima.

If you are reporting an accident, please follow these procedures:

1. Immediately report the injury to your supervisor.
2. Complete an Incident Report Form and send to Lara at the District Office.

If you are reporting an injury and will be seeking medical attention, please follow these procedures:

1. Immediately report the injury to your supervisor.
2. If the injury is non-life threatening, you must go to the District Office to complete the "SIF2 - Self Insurer Accident Report Form" This form must be completed in the District Office it cannot be taken with you. At this time you will be given a copy of the SIF2 form, along with your claim number for treatment.
3. If you have a serious injury, please go directly to the hospital; request that the hospital call and we will submit the claim number to them. You will need to follow up with the above paperwork.
4. Complete your part of the Physician Initial Report and have physician mail to:

Please do not use the State Fund (Labor and Industries) State of Washington form at the doctor's office and/or hospital. The Self Insurer Accident Report Form (SIF 2) is your request for benefits. There is NO OTHER SOURCE for your CLAIM request. The SIF 2 is the most important form in the process, and your responsibility. This is imperative if the claim is to be processed properly and in a timely manner.

FORMS:

• WC Flow Chart
• Accident Incident Injury Report
• Witness Statement
• Supervisor Statement

CONTACTS: