University of Central Arkansas

When a workers’ compensation injury occurs the injured employee’s supervisor or other person designated by the employer should make sure that the claim forms are filled out and faxed to the Office of Human Resources at 501-450-5088.   Send original to Wingo Hall, Suite 106, Attn:  Ruby Burroughs.

Employer's First Report of Injury or Illness (To be completed by employee)

Employee's Report of Accident (Form PECD 1) (To be completed by employee)

Employer's Report of Accident (Form PECD 2) (To be completed by supervisor)

Employee's Notice of Injury (Form N) (To be completed by employee)

Supplemental Report (Form S) (To be completed by employee)