Injury Report Form

Thank you for using the online Injury Report Form (Workers Comp). The purpose of this form is to report injuries sustained on assignment by Teachers On Call substitutes. The injured party should submit this form. In the event of an emergency a third party representative may submit the form on behalf of the injured TOC employee.   

Call TOC immediately to obtain a health pass for treatment if you are seeking medical treatment for an injury. You will be connected with an individual who will email you the necessary information for medical assistance. You can also ask to speak with an HR Associate if you need help completing this form or have other questions regarding work comp. Please send additional questions to

Work-related injuries should be reported to TOC by the end of the day in which the injury occurred. Doing so will ensure the claim is processed in a timely manner. Late claim submissions or submissions from unapproved parties may result in denial. 

In the event of a medical emergency, call 911 for immediate assistance. 

Your Name (injured TOC employee).
teacher, paraprofessional, custodian, etc. 
Absence Management Confirmation number of your worked assignment. This confirmation number will help verify your injury occurred while you were working as a TOC substitute. 
Signed-in (start time) of your assignment. 
Signed-out (end time) of your assignment. 
Select specific date injury incident occurred (which may or may not vary from your date reported). 
Time incident took place 
Facility Category
Provide which specific building your injury took place at.  
This number can be found in your Absence Management account under your assignment details. 
Please provide specifics of what you were doing at the time of the injury (actions, events, tasks, interactions, etc).  
Presenting symptoms caused by injury. 
Location of injury on body
What do you believe caused the injury to happen? 
Was there a specific device(s)/equipment required for the task?
Did the school/center train you how to safely use the above device(s)/equipment?
Please list all formal and informal treatments (cold/warm compresses, medication, etc.). 
Did/will you seek medical treatment after your shift?
Employees may choose to seek medical treatment for their work injury. When/if an employee determines medical treatment is needed, they are to call TOC at 800-713-4439 to obtain a health pass for treatment.  
If you were injured during this incident, have you experienced a prior injury, illness, or had prior treatment to this same body part/body system?
Initial disclosure of this information is essential to ensure appropriate medical care is addressed and can help a medical provider in determining when you have returned to your pre-existing status.   
Were there witnesses to the incident/injury?
Have you returned to work?
What days do you normally work?
Answering the above questions will provide TOC with the information needed to submit your work comp claim. Typically, you will not need to submit an injury report to the school directly, as TOC handles all claims for TOC employees.   Additional questions, feedback and concerns pertaining to this report can be emailed to  or faxed to HR at 1 800-713-3299.