In the event of a work-related injury or illness you are required to report it to your supervisor, the school nurse, or to Human Resources immediately.  Our workers' compensation insurance company, Primex, will contact you and may provide a nurse case manager for guidance. Their goal is to assist you in maximum recovery and safe, prompt return to meaningful work.  

    The employee’s  responsibility is to completely fill out the Employees First Report of Injury Form immediately and submit this to your nurse’s office or administrator who will forward this to the Human Resources Department.  Because you verbally told someone that you were injured at work does not take the place of reporting an employee injury using this form and giving to the correct contact. The date reported should be the date you filled out this form which oftentimes is the date of injury.  However if you do not fill out this form right away, that date should be the date you filled out the form and submitted to nurse, administrator or HR. The District has no later than five (5) calendar days to report the information that you provide to the State of NH based on the report date on your form.  If not reported within this timeframe, the district is then subject to a fine of up to $2,500.00. This form can be found in the nurse’s office, Human Resources office,  as well as the main office of your building or on our website.

    Special Notes:  

    • Student related injuries should also be reported on the Employees First Report of Injury Form.
    • Form must be filled out completely with a detailed description of how the injury occurred as well as all parts/sides of the body that were injured.
    • The date reported should be the date you submit the form for processing.
    • In the case of an emergency, the administrator or nurse can take your statement of injury and report this to HR dept.
    • The form is also on our website- Departments>Human Resources>Safety>WC First Report of Injury
    • If you cannot find the nurse or administrator to hand your completed form to, please scan this form to Karen Stuart in HR-  k.stuart@sau33.com
    • Your administrator will be doing an incident review of your injury so we may track injuries and improve all safety measures.

    You have the right to choose your own doctor if you are hurt at work. If you seek medical treatment, be sure to inform the medical provider to send all medical reports and bills to:


    Attn: Workers’ Compensation Claim Department

    46 Donovan Street, Concord, NH 03301-2624


    Your doctor will give you a New Hampshire Workers’ Compensation Medical Form after your appointment, with any restrictions necessary, to bring with you back to work.  Please bring this form to the Human Resources Department and your administrator. We will discuss the physician’s restrictions with you and place you in temporary alternative duty, if necessary.  Your nurse case manager from Primex works as a resource for all parties. 

    The staff at Primex would be pleased to answer your questions and concerns about your medical care or the workers’ compensation system.  You may call them at 1-800-698-2364. Please see the link below to the Department of Labor website and read more about workers’ compensation:


    Please contact Karen Stuart in your Human Resources Department with any questions you may have about workers' compensation.

Related Files

Safety Documents