Andrews Independent School District (AISD) provides
Workers’Compensation Insurance, as required by Federal and State Regulations, to protect its
employees in the event of work-related injury or illness. This is the District’s responsibility
to each employee. Our current Workers’Compensation carrier is Claims Administrative Services.
This coverage is effective from September 1, 2007. Claims Administrative Services will handle any
injuries or illnesses that occur on or after that date.

As an employee of AISD, you may elect to retain your
common law right of action if, no later than five (5) days after beginning employment, you notify
Andrews ISD in writing that you wish to retain your common law right to recover damages for personal
injury. If you elect your common law right of action, you cannot obtain workers’ compensation
income or medical benefits if you are injured.

Should an employee be injured on the job, the following guidelines
must be used to report the injury:

1. Your immediate supervisor and/or principal
should be notified of the injury within 24 hours. If you are injured over the weekend
(for example, on a school sponsored trip, etc.),please contact your supervisor by
Monday morning.

2. You must complete a WC-1 Notification of Injury Report
and give to your supervisor. Be sure to sign the report. All supervisors must also sign this report.

3. If you are a supervisor,you must complete a LC-6-94
Supervisor’s Injured Employee Investigation Form and turn into the Business Office so that the
Workers Comp. Carrier can be notified of the injury. PLEASE CALL THE BUSINESS OFFICE TO REPORT
THE INJURY ALSO. Many times the Hospital or Doctor’s offices will call to verify the injury and the
Insurance Department has not been notified, which causes a delay in services.

4. You can get more information about Workers’
Compensation rights from any office of the Texas Workers’ Compensation Commission, or by
calling 1-800-252-7031. The Commission provides free information about how to file a claim,
as well as, explaining your rights and responsibilities under the Workers’ Compensation Act.

5. The Commission has established a 24-hour
toll-free telephone number for reporting unsafe conditions in the workplace that may violate
occupational health and safety laws. Employers are prohibited by law from suspending, terminating,
or discriminating against any employee because he or she in good faith reports an alleged
occupational health or safety violation.
Contact the Division of Workers’ Health and Safety at 1-800-452-9595.

District Supervisor's Injured Employee Investigation Form 
(printable form)

Workers' Comp Insurance Carrier Form 
(printable form)