AGENCY: Box Elder County School District (Utah). Department of Business Administration

SERIES: 14727
TITLE: Worker's Compensation Employee's first report of injury
DATES: 1960-
ARRANGEMENT: Chronological, thereunder alphabetical by employee surname

DESCRIPTION: Required by the Industrial Commission in connection with UCA_ 35-1-97 and 35-2-103 (1994).to report any work-related fatality, injury, or any occupational disease resulting in medical treatment, loss of consciousness, loss of work or restrictions of work. Each school and district office completes and sent to the business administrator in cases involving an employee who is injured on the job and/or meets one of the criteria specified in UCA_35-2-103_(1993). The district completes, signs, and mails the report to Workers Compensation within seven days as prescribed by law.

RETENTION

Retain for 5 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 09/1995

FORMAT MANAGEMENT

Paper copy: Retain in Office for 5 years and then destroy.

APPRAISAL

Administrative

This disposition is based on the administrative needs expressed by the district's business administrator.

PRIMARY DESIGNATION

Private