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Workers' Compensation (Begins 9.1.19)


Workers' Compensation

Georgetown ISD provides Workers' Compensation benefits to employees who become injured or ill on the job. Workers' Compensation provides employees with medical benefits and, in some cases, weekly income payments (known as Temporary Income Benefits), if you experienced a work-related injury or occupational illness. All work-related incidences must be reported to the Supervisor immediately (even if they do not seek medical attention) and the necessary information below must be completed immediately, no later than 24 hours of the incident time/date. Review the Employee Notice of Alliance Requirements (English or Spanish), DEC Local, DEC Legal, and CRE Legal policies for more information. 

Once you report an on the job injury or illness you supervisor and you must fill out the form below and return the documentation to the Campus Nurse or Department Admin Assistant immediately, no later than the next business day after you report. If the incident is life-threatening please call 911 and notify the immediate Supervisor. Once you are stabilized, please complete the necessary Workers' Compensation documentation below.


Step 1:

  1. Rights & Responsibilities - (English or Spanish)
    • Documents for your records only (no action required)
  2. First Report of Injury - (FROI pdf) 
    • Complete line item 1-29, 40, and 51 (No. 51 - employee signature)
    • First Report of Injury- Campus Instructions 
  3. Acknowledgment of Alliance - (English or Spanish)
    • Complete the required fields (name, signature, etc.)
  4. Leave Election Form (Non-Offset) - (English or Spanish)
    • Complete the required fields (name, position, date of injury, signature, etc.)
    • Select one of the three boxes (
      Check box icon
    • District authorized signature (leave blank)
  5. Provider Finder - (Provider Locator or Top 5 Network Providers)
    • Documents for your records only in case you decide to seek medical attention
    • You have the option to utilize a user-friendly provider finder search engine or a GISD Provider Finder document
    • Please be sure to contact the location before your departure

** If you have a desire to seek medical attention ensure to see the Campus Nurse or Department Admin Assistant for a Verification of Employment form to take to your doctor and First Fill Medication card to take to the pharmacy - proceed to Step 2**

Step 2:

  1. Prescription First Fill Form - (English or Spanish)
    • Complete the required fields (Name, date of injury, etc.)
  2.  Verification of Employment Form - (VOE)
    • Complete the required fields (Name, date of injury, etc.)

After the completion of steps 1 and/or 2:

  • Return the completed documents to the Campus Nurse or Department Admin Assistant to send to the Human Resources department
  • This information will be sent electronically via fax or email to Human Resources
  • You're able to keep the original copy for your record-keeping purposes

Texas Association of School Boards (TASB) is Georgetown ISD's Workers' Compensation Insurance carrier. If you seek medical attention, a TASB Workers' Compensation Adjustor will contact you directly.

If you have any questions or concerns, please contact Brooke Irwin, Benefits & Leaves Coordinator at 512.943.5000 ext. 6092.

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