The On-The-Job Injury & Illness Program (OJI) is responsible for coordination of benefits payable, including medical expenses and lost wages, to any employee who may have an injury and/or illness sustained in the course of, and arising out of, employment at UAB.

Other OJI Forms. After Filing an OJI Claim. Employee Accommodation Plan. OJI Employee Appeal Request. OJI Employee Drug Collection and BAT Authorization Form. OJI Program Acknowledgement Form - Initial. OJI Program Posting. OJI Supervisor Checklist. Panel of Physicians. Administration. Budget & Finance; County Attorney;

Welcome to ODJFS Forms Central. At this site you will find the forms currently used in ODJFS programs. The purpose of Forms Central is to provide customers and staff with a dynamic listing of all ODJFS forms along with the capability to order forms online.

Complete the OJI Claim Forms and submit to [email protected]. Forms should be completed whether the employee is seeking medical treatment or not. If the employee chooses not to seek treatment check Report Only at the top left of the form. The employee will have 7 days counting the day of the incident to seek treatment.

The OJI claims for the City of Memphis are classified into four categories: Exposure, a Regular On-the-Job Injury, Occupational Illness/Disease (HHL) and Death. Each claim will be classified as either a Notice Only, Medical Only or Lost Time.

Submit an OJI Claim form, employee injury statement, supervisor interview form and witness statement to the Insurance and Risk Management Department by email or fax. Email to: Employees are required to select a clinic from the panel on the OJI Claim Report when they complete the form. These are the only approved treatment facilities for an OJI.

Ensure the following forms are completed and submitted to the Insurance & Risk Management Department for any reported injuries, incidents, and/or illnesses whether the employee is seeking medical treatment or not.

injury/illness” qualifying for benefits under the UAB On-the-Job Injury/Illness Program. An OJI Benefits Application* must be completed, signed and submitted to Brentwood Services Administrators as noted in the How to Apply for OJI Benefits* document. *Forms can be accessed on the Instructions and Forms for OJI webpage

The OJI program is a benefits program that provides medical, income, and death benefits to qualified employees due to injury, illness, or death resulting from a compensable work-related claim. In addition to these benefits, the injured employee also has certain responsibilities.

DO NOT COMPLETE FORM ONLINE. To submit, download to your device and submit using the button below, email PDF to [email protected] or print and submit to OJI Administrator | AB 215. • VISITOR/STUDENT REPORTS: Print and submit to Risk Management | 500 Bldg Suite 504. INFORMATION ABOUT THE PERSON INVOLVED IN THE INCIDENT: Full Name: Last 4 SSN#: