Workman's Compensation

1. Employees MUST report an on-the-job injury or illness IMMEDIATELY to their supervisor, regardless of how slight. 

2. Once an injury has occurred, contact  your Safety Coordinator, They will require you to fill out the Employer’s First Report of Injury (Form 122) so that it can be reported to UDOT’s insurance carrier, Workers Compensation Fund of Utah.

1. Employees may be provided with a packet whenever they suffer an injury.

2. The front of the packet has a business card for contact with the UDOT Safety Contact for your area as well as a business card that the employee takes with him/her to the treating provider. This card provides the attending physician with the necessary information for their billing purposes.

Workmans Compensation Packet for Regions

• This form should also accompany the employee if treatment is sought. This will ensure that any work limitations or restrictions are properly noted.

• Employees cannot return to work without an Attending Physicians Release to full duty or any restrictions that may apply. RESTRICTIONS MUST BE SPECIFIC

• Once the doctor has completed this form, the employee must return this form to his/her Safety Coordinator.

• If light duty work is available per your supervisor and UDOT Safety Coordinator and meets the work restrictions given by your doctor, you must report for work or forfeit workers compensation wage replacement benefits.

Contact:

Keith Bladen

Employee Safety Program Manager
Utah Department of Transportation
4501 South 2700 West | Salt Lake City, UT 84114-8430
Office: 801-791-2412 | kbladen@utah.gov 

Region Safety Contacts