Human Resources

4 Summer St., Rm 104, Haverhill, MA 01830 | Office Hours 8:00-4:00 | Phone (978) 374-3411 | Fax (978) 374-3422

  • Work Injury Reporting

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    Work Injury Reporting – School 

     

    School instructions for reporting injuries 

    Please read this before completing the forms to report an injury.  Forward completed forms, via email to HRD@cityofhaverhill.com AND cmcauliffe@haverhill-ps.org, for processing.

    Form 118

    This form should be completed by someone other than the injured employee.  Complete this form if the employee is going to be out for less than 5 work days.  The Medical Authorization Form MUST be signed by the employee.

    Form 101

    This form should be completed by someone other than the injured employee.  Complete this form if the employee is going to be out for 5 or more work days.

     

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