Workplace Injury Policies, Procedures and Forms

Injury Reporting Policy

All employees must understand the City of Pittsburgh Injury Reporting Policy as part of their employment with the City of Pittsburgh.  This policy directs the injured employee’s supervisor as being responsible for initiating what needs to be done by the employee when injured.

Injury Reporting Policy


Worker’s Compensation Forms

The City of Pittsburgh worker’s compensation program is managed by UPMC WorkPartners and it is important for all employees to understand their responsibilities when they are injured in the workplace.  All injury claims, whether or not they require medical attention, must be called into UPMC WorkPartnters at 1-800-633-1197.  The forms below detail employee’s responsibilities as require by the PA Department of Labor and Industry.  These forms must be signed by injured employees at the time of injury and forward to the Department of Human Resources Office of Risk Management.

Workers' Compensation Information Form - All Employees

City of Pittsburgh Workers’ Compensation Health Care Panel Provider Panel - All Employees except Fire Bureau IAFF Local 1 members

City of Pittsburgh Workers’ Compensation Health Care Panel Provider Panel - only Fire Bureau IAFF Local 1 members


Work Injury Reporting Forms

It is imperative that all employees who are injured during work complete a Work Injury Form so that there is a clear understanding of the factors which contributed to the injury.  Please use the form below that is appropriate to your job position.

City of Pittsburgh Injury Form - Non Police/Fire Employees

Police Officer - City of Pittsburgh Injury Form

Firefighters - City of Pittsburgh Injury Form


Infectious Disease Reporting Form

Many employees must interact closely with the public and are at risk of infectious disease transmission.  In these situations, the employee involved is to contact UPMC WorkPartners to relate to them the circumstances surrounding the exposure incident.  In addition, the City of Pittsburgh Infectious Disease Exposure Form must be completed and forwarded to the Office of Risk Management so that a complete understanding of the situation and all City of Pittsburgh employees involved can be determined.  For more information on occupationally acquire infectious diseases and the precautions to avoid infection, please refer to the Infectious Disease Control Program Exposure Control Manual.

Infectious Disease Exposure Form

Infectious Disease Control Program Exposure Control Manual


Injury Investigation Form

Each injury to City of Pittsburgh employees must be investigated to determine the root cause of the injury and to determine if there are any corrective actions that can be taken to assure others are similarly injured.  The investigation is to be done by the employee’s immediate supervisor who is most familiar with the injured employee’s job duties.  The Safety Office is always available to assist in these investigations.

Injury Investigation Form


Post-injury Drug and Alcohol Testing

All employees who need to seek medical treatment for an injury will be post-injury drug and alcohol tested to determine if drugs and/or alcohol contributed to the injury.  Please see the policies below regarding these procedures.

Post-Injury Drug & Alcohol Testing Policy

Drug-Free Workplace Policy


Injury Occurring in a Vehicle Accident

Should an employee of the City of Pittsburgh be injured in a vehicle accident while working, in addition to the forms mentioned above, they must also complete and distribute a Motor Vehicle Accident form.  This important document details the particulars of the accident as well as identifying the other vehicles or properties involved in the accident.

Form 50 - Motor Vehicle Accident