What to do if you are injured at work and need medical attention click on left side of mouse button to go to next slide

Employee Report of Injury After notifying your supervisor and contacting Risk Management at or complete this form. Send to RM within 48 hours of your injury. If the injury report is not received in our office within 72 hours of your injury you will be required to come into Risk Management and complete the form. click on lps.org to take you to the website to get this form. The form number is in the top left hand corner. Single click on left side of mouse to go to next slidelps.org This form can be found on

Nebraska workers’ compensation law states you have the right to choose a physician who has a record of treating you or an immediate family member prior to your injury. If you do not have a record of treatment with a physician or your physician does not take workers’ compensation you will then need to be evaluated at one of the district’s designated treatment facilities. Single click on left side of mouse to go to next slide

Employee Choice or Change of Doctor Form This form should be completed prior to seeking medical treatment. Be sure to complete Part A and Part B and turn in with your Employee Report of Injury. Click on lps.org to take you to the website to get this form. The form number is in the top left corner Single click on left side of mouse to go to next slidelps.org

Release to Return to Work Each time an employee is evaluated by a physician for a work injury they will need a new release. Custodians should take the release to CTS first and CTS will send the release to Risk Management. All other employees should bring or fax the release to Risk Management. It is your responsibility to make sure Risk Management receives a copy. You will not be allowed to return to work without a release. As tolerated is not accepted on a release Employee should sign release stating they are aware that their restrictions apply at work and at home. Click on lps.org to take you to the website to get form RM0005. The form number is in the top left corner Single click on left side of mouse to go to next slidelps.org

When you report your injury to Risk Management and are not going to your physician, you will be given the phone number for Madonna Fit for Work so you can call and an appointment time will be scheduled at one of these facilities. If it is during regular business hours do not contact these facilities to make your own appointment. Single click on left side of mouse to go to next slide

After Hours Care Urgent Care at Life Pointe 7501 S. 27 th St. M-F 8 a.m. – 8 p.m. Sat. & Sun. 9 a.m. to 5 p.m Heartland Urgent Care 965 South 27 th Street, Suite D M-Sat. 8 a.m. – 8 p.m. Sun. 10 a.m. – 6 p.m Fallbrook Family Health Center 755 Fallbrook Blvd., Suite 100 M-Th 7 a.m.- 7 p.m. Fri. 7 a.m.- 5 p.m. Sat. 9 a.m. to noon Single click on left side of mouse to go to next slide If you have an injury after hours notify your supervisor of your injury. You may go to one of these facilities for treatment or an emergency room if the injury warrants treatment there. If you have an injury after hours notify your supervisor of your injury. You may go to one of these facilities for treatment or an emergency room if the injury warrants treatment there.

Please review the HR#2 it provides information on workers’ compensation and what is expected from you and what you can expect when filing a claim. Single click on left side of mouse to go to next slide

Single click on left side of mouse to go to next slide

How to access all Risk Management Forms

Go to the lps.org webpage and type the word “forms” in the keyword box click on left side of mouse to move through slides

In the drop down box find Risk Management, hit enter

On the website click on the form you want and print.

If you have any questions regarding this process please contact Risk Management at or