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 – Workers’ Compensation

    Injury Forms – School   clip art school

     

    Instructions/Protocol for reporting work related injuries – Please read this before completing the forms to report an injury.  Please forward completed forms, via email to dmcclanahan@cityofhaverhill.com or interoffice mail to City Human Resources Office, Room 306, City Hall, for processing.  Also, please forward a copy of the forms to Nina Torrisi in the School Human Resources Office, via email to nina.torrisi@haverhill-ps.org.

    Directions to Occupational Health Center

    Sample Occupational Health notice

    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.

    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.

    Medical Authorization form – Complete this form if you seek medical treatment at a facility other than the Occupational Health Center at Anna Jaques.

(978) 374-3400
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