ACPS employees must report a workplace injury to their supervisor and CorVel, the third-party administrator. To report the injury to CorVel, call 1-877-764-3574 and speak to a Triage Nurse. Once the incident has been reported to CorVel, the employee must complete the Notice of Injury/Illness and Authorized Panel of Physicians Acknowledgement and Selection forms below. These forms must be submitted to the supervisor and then forwarded to Human Resources.
- Notice of Injury, Illness and Investigation (PDF)
- Authorized Panel of Physicians Acknowledgement and Selection Form (PDF)
- Authorized Panel of Physicians for Workers' Compensation (PDF)
- Inova Alexandria Hospital Workers' Compensation Worksheet (PDF)
- Injured Worker's First Fill Prescription Information Sheet (PDF)
- Authorization for Release of Medical Information (PDF)
- Job Related Work Status Report (PDF)