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If you have an accident at work, please contact your supervisor and call our Nurse Triage Helpline at 833-WCT-NURS (833-928-6877) as soon as possible.

All staff on an unpaid leave, or a leave of absence that is more than five (5) days, are required to complete an Extended Leave of Absence form.

Accident/Injury & Return to Work Program

Riverview School District is dedicated to providing a safe and healthy work environment for all employees and strives for prevention of work-related injuries. Should a work injury occur, the District has developed a work injury process that includes a team approach to assist employees with prompt, quality medical treatment, and a safe and successful return to work. 

Please see the following required forms for claim processing:  

Activity Prescription Form (APF)

Puget Sound Workers' Compensation Trust considers the effective use of the Activity Prescription Form (APF) as a best practice in occupational medicine. The form communicates an injured worker's physical restrictions and ability to work as well as the provider's treatment plans. In addition, workers' time-loss benefits depend on the APF and your chart notes.

Provider's Initial Report (PIR)

A Provider’s Initial Report (PIR) is completed by the Provider and the Employee and establishes a claim. When the completed PIR is received by the HR/Return to Work Coordinator or Puget Sound Workers' Trust the PIR will be matched with your claim number. If you have not yet filed the online claim you will be directed to call our Nurse Triage Helpline for assistance, 833-WCT-NURS (833-928-6877).  

Time Loss Election Form

Employees who are injured on the job and will be off work for more than three days following the date of injury, may be eligible to supplement their time-loss benefits with sick, personal, vacation, comp, or another similar leave accrual benefit. If an employee is found eligible for time loss payments, the employee has a choice on how they wish to supplement the time loss payments. The required Time Loss Election Forms should be completed at the time of filing a claim. 

Please see the following form to be completed by an employee returning from an extended medical-related leave: Release to Return to Work

Employee - Work Injury and Compensation FAQs

Q. If I want to reserve my paid leave accrual while off work, do I have this option?


A. Yes, the only time an employee has an option in reserving sick leave during an illness or recovery, is during a work injury recovery. All employees who wish to reserve leave accrual, should complete a time loss election form and choose option #1. This will stop your sick leave and revert to unpaid time while you continue your recovery.   

Q. Do I have the option to use part of my leave accrual and receive time loss payments? 

A. Yes, if your claim is approved and you receive time loss payments from Puget Sound Workers' Trust, you may choose to participate in our sick leave buy back process. The District will receive a copy of your time loss payments and calculate a value that will determine the amount of sick leave you may buy back. We will then deduct this amount from your next available paycheck and reimburse your sick leave balance. All employees who wish to use this option, should complete a time loss election form and choose option #2. 

Q. Do I have the option to use all my leave accrual while receiving time loss payments?  

A. Yes, employees may elect to use all leave accrual such as sick leave, personal leave and/or vacation while off work. In addition to your paycheck from the District you may also receive time loss payments from Puget Sound Workers' Trust. The District will apply all available leave to missed days from work, until all leave accrual is exhausted. All employees who wish to use their leave accrual AND receive time loss payments should complete the time loss election form and choose option #3.

Q. Am I eligible for Shared Leave while off work due to a work-related injury?

A: You the ability to participate in the Shared Leave Program while you are off work due to a work-related injury. You must exhaust all available leave accrual before receiving leave share donations. Donated leave will be applied using a calculation to determine the difference between Time Loss Benefits and your usual full compensation from the District.

Q. If Puget Sound Workers' Trust requires me to attend an Independent Medical Exam, am I required to use my sick leave?

A. No, if you have been asked to attend an Independent Medical Exam by Puget Sound Workers' Trust, please notify the HR/Return to Work Coordinator with notification of this appointment. The District will not charge your sick leave for time away for this purpose.

Q. If I am cleared by my doctor to return to work, but I have work restrictions, what should I do?

A. If you have been cleared by your doctor to return to work with restrictions, you should fill out a Release to Return to Work form and be in immediate contact with your HR/Return to Work Coordinator to set up a meeting and discuss return to work options.

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