ACPS employees must report a work place 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. More information on the Workers' Compensation policies and procedures and frequently asked questions are available on Blackboard.
- 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)