Montana State University-Northern
Workers' Compensation
Forms

Incident Report:
An Incident Report is filed for any incident happening on campus that is not covered by Workers’ Compensation or the person doesn't wish to file a Worker’s Compensation Report. This form is available by clicking on the link above.

Near Miss Incident:
The Report of Unsafe or Unhealthful Working Condition or a Near Miss Incident form is provided for the assistance of employees at MSUN and is not intended to constitute the only method by which a report may be submitted. A near miss is defined as an incident that has the potential to cause serious injury or property damage. The incident reveals a physical condition or employee action that could lead to future serious injury or property damage if not corrected. This form is available by clicking on the Near Miss Incident link above.

Subsequent Injury Fund:
The Legislature established the Subsequent Injury Fund in 1973 to assist persons with disabilities to become employed by offering a financial incentive to employers who hire certified workers. The Fund is generated through an annual assessment of all Montana insurers. The assessment is allocated among insurers based on their compensation and medical payments for the previous calendar year. Click on the Subsequent Injury Fund link above for further information and click on this Subsequent Injury Fund Questionnaire link if you think you qualify for this fund.

Volunteers:
Volunteers are not covered under Worker’s Compensation. If an accident happens, file an Incident Report. The person is covered under their own health insurance.

Other forms:
Be sure to read the Procedures page for information on the following forms:

Top