Ocean Prime - Chicago - Associate - CMR RISK & SAFETY HEADQUARTERS

Employer instructions:
For serious injuries, call 9-1-1 right away.
For all other injuries, please call the TravCare line for 24/7 medical guidance from a nurse who can recommend the appropriate level of care and start the worker's compensation claim for you. TravCare: (800)238-6225
Lastly, you can also use the form below if no medical care is needed.

Associate Injury Reporting Form

Please be sure to fill out each field in its entirety using the ASSOCIATE'S information, NOT the store.

* Indicates required field

Store Number & Name *

Policy Number *

Associate Name *

Manager on Duty *

Associate Address *

Line 1

Line 2

City

State

Zip Code

Country

Associate Date of Birth *

Associate Job Title *

Associate Phone Number *

Date of Injury *

Time of Injury *

Cause of Injury *

Did the associate leave their shift to seek medical treatment? *

Yes No

Submit

Provide the information at the link below to the associate.

Employee Injury Packet