Rusty Bucket - Indianapolis - Associate - CMR RISK & SAFETY HEADQUARTERS

Employer instructions:
For serious injuries, call 9-1-1 right away.
For all other injuries, please call the WesCare 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. WesCare: (844)380-2743
Lastly, you can also use the form below if no medical care is needed.

Associate Injury Reporting Form

* 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