Workers’ Compensation

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How to report and accident/injury

Employees who are injured on the job should immediately Call AmeriSys at 800-455-2079 to report the workers’ compensation claim. Be prepared to provide the following information.

  1. Employee ID
  2. Full name
  3. Home address
  4. Phone number
  5. Job title
  6. Date of birth
  7. Sex
  8. Social Security Number
  9. Date of accident
  10. Time of accident
  11. Description of the accident
    • Being as descriptive as you can, indicate how the accident occurred. Be sure to tell us what the cause of the accident was. Include your direct supervisor or contact person’s name and campus phone number.)
  12. Injury/illness that occurred (Ex. Bruise, strain, cut, scrape, contusion, etc.)
  13. Part of body affected
    • Indicate the part of your body affected by the injury. Be sure to specify “left” or “right” when appropriate, and be specific as to the area injured (Ex. “left wrist,” “right knee,” “lower right back”).
  14. Date first reported to your supervisor.
  15. Employer’s address:
    1. Florida Polytechnic University, 4700 Research Way, Lakeland FL, 33805-8531, Telephone: 863-583-9050
    2. The location number is: 0272
    3. Florida Industrial and Phosphate Research Institute location number: 0273

If you need additional assistance, contact Human Resources at 863-874-8421 or email DeAnn Doll. Please report the accident to the Facilities and Safety Services Office at 863-874-8691.

Site maintained by the Human Resources Department