Additional Safety Protocols

DMP Program Procedures

UND participates in the Risk Management Workers Compensation Program. This allows the Risk Management Workers Compensation Program (RMWCP) to designate health care providers to treat your workplace injuries and illnesses. Workforce Safety and Insurance may not pay for medical treatment to another provider unless you are referred to this provider by the designated medical provider, or you have designated in writing prior to the injury that you wanted to be treated by a different medical provider. If you need to seek medical attention due to a work-related injury, you must see a designated medical provider (DMP). Emergency care is exempt from this designated provider requirement.  

Altru Occupational Health/Employer Health Solutions has been selected for the Grand Forks Area as it has an occupational health services department with an occupational health physician as the attending physician. An occupational health physician specializes in work-related injuries/illnesses. UND employees working outside of Grand Forks must seek medical treatment from one of the following if injured on the job:

• Sanford Health Occupational Health – Bismarck, with satellite clinics in Jamestown and Dickinson.
• Trinity Health Occupational Medicine - Minot, with satellite clinics in Mohall, Sherwood, Parshall, Cando, Stanley, Bottineau, Velva, Westhope, Garrison, New Town, Kenmare, and Williston.
• Sanford Health - Fargo, with satellite clinics in Enderlin, Hillsboro, Mayville, Wahpeton, Valley City, Edgeley, Lisbon, Jamestown, Grafton and Park River. 
• Altru Health Occupational Medicine - Grand Forks, with satellite clinics in Drayton, Cavalier, and Lake Region in Devils Lake 

UND Student Health Services is not a designated medical provider for the University.  

Employees intending to see a medical provider other than the University’s DMP must designate this in writing on their DMP form prior to an injury. This includes not only physicians, but chiropractors, dentists, optometrists/ophthalmologists, etc.

The DMP form can be found by logging into Employee Self Service.

If your job should require you to be out-of-town for a short period, you are urged to seek an After-Hour Clinic or an Urgent Care/Emergency facility. Additionally, if your job will require you to be away from North Dakota for more than 28 days whether out-of-state or overseas, you must fill out the Out-of-State Workers Compensation Coverage Form or the Travel Outside the U.S. Form and the Notification of Out-of-Country form and submit to the Office of Safety at Stop 9031 or e-mail them to: UND.safety@UND.edu. 

If you do not have a DMP on file or need to update your DMP, please log into Employee Self Service.

If you have any questions about the designated medical provider policy, please contact the Office of Safety at 701.777.3341.

See the UND Department of Safety Incident Reporting and Investigation webpage.

Incident Reporting and Investigation Forms

Employee

• Notify your supervisor as soon as reasonably possible. Your supervisor will assess the situation, assist with arranging proper medical care and begin the injury reporting process.
• Cooperate with your supervisor and the Workers' Compensation Specialist in the completion of all relevant documents.
• Provide a status report to your supervisor within 24 hours.
• Provide regular updates to your supervisor regarding appointments for your work-related injury.
• Provide restrictions/workability notes to your supervisor and Workers' Compensation Specialist upon receipt. A photo of the paperwork is acceptable.
• Forward all medical bills to the Workers' Compensation Specialist for payment.
• Provide the clinic/hospital with your claim number and Workers' Compensation Specialist contact information to help prevent direct bills.
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Supervisor

• Immediately assess the incident and assist the employee in seeking appropriate medical care or necessary treatment for any work-related injury. Call 911 if an injury is a potential life-threatening emergency.
• Within 24-hours complete the online Incident Report form
• Document all workplace injuries via the Incident Report form, regardless of whether the claim appears to be compensable.
• For guidance on specific eligibility or coverage questions, please contact the Workers' Compensation Specialist.
• Forward employee workability notes to the Workers' Compensation Specialist. Please note, you do not need to send them the actual medical documents.

The Medical Provider must complete a Report of Workability and provide it to the employee. The Report of Workability will indicate when the employee can return to work and whether job modifications are required to accommodate physical restrictions. The employee must provide a copy of the Report of Workability to the supervisor and Workers' Compensation Specialist.

Employees without restrictions can return to their usual work duties.

If the medical provider imposes work restrictions, the supervisor, the University Disability Services (HR), and Workers' Compensation Specialist will review the job modifications that are required to comply with the restrictions. Every effort will be made to accommodate the employee's restrictions.

If work restrictions cannot be accommodated by the employee’s home department, the University Disability Services will review the work restrictions and find suitable modified work elsewhere within the University for the injured employee while on restrictions.

If work is available within the restrictions, the employee will return to suitably modified work.

The University of North Dakota is required to procure alternative workers' compensation coverage for any employee working outside of the state of North Dakota for any period exceeding 28 calendar days. The Risk Management Workers Compensation Program coordinates the purchase of this required coverage for all state agencies through its broker.

This coverage also applies to employees working 100% remotely/off-campus outside of the state of North Dakota.  If an employee works remotely (outside of ND) on a partial basis and on campus on a partial basis during the month, there is no need for a change.

For new employees, this coverage MUST be in place at the time the employee begins their duties for the University. Part-time employees, adjunct faculty, etc. must also be considered. Please remember that if a new employee will work away from the campus on a regular basis, a Flexplace Agreement must be submitted prior to their offer.

Below is a form that must be completed when a department needs to obtain out of state coverage for a UND employee. The form needs to be completed by the department, not the employee. 

Out of State Workers Compensation Coverage Form

The University of North Dakota is enrolled in workers compensation coverage with Workforce Safety & Insurance (WSI) for those individuals who work at the University in a volunteer capacity.

This primary reason that UND has secured this coverage is for those volunteers that perform tasks that are normally done by UND faculty/staff. Coverage is required for tasks of a hazardous nature (ie. working with hazardous materials, driving, operating equipment, exposed to the outdoor elements, etc.). If a department uses the same volunteer on a frequent basis, they should secure coverage for them. 

The department must fill the form out in its entirety and submit it to the Office of Safety before the individual does their volunteer work for the University. The departments will be assessed $12.45 from WSI per volunteer. It is strongly encouraged that the departments try to utilize the same volunteers. The volunteer may perform tasks many times throughout the year and the assessment would remain at $12.45. Department must fill in the fund number, department number, and program or project code. When the premium notifications are received from WSI, Office of Safety will bill back the department and it is imperative that this information be provided. If the volunteer is injured while working for the University, notify the Office of Safety and a claim will be filed for them online with WSI.

If the volunteer is injured and cannot work his regular job, the volunteer does qualify for time loss wages. This does not affect the assessment that the University pays. The types of tasks they perform will not reflect on the rate either.

If a department has filled out a form and then finds out that the volunteer can no longer work for the University, the department must contact the Office of Safety at 7-3341 so coverage can be discontinued. 

Volunteer Form Instructions

Volunteer Workers' Compensation Form

Volunteer Waiver

Contractor/Working Visitor Form

All covered individuals must submit the Animal Exposure Risk Assessment Form (Appendix A) annually.

Appendix A - Animal Exposure Risk Assessment form

Each covered individual, with assistance from the principal investigator/supervisor, is required to complete the Occupational Health Risk Assessment Questionnaire (Appendix B), which may include consideration of animal allergens, infectious agents, chemical hazards, and physical hazards. 

The Occupational Health Risk Assessment Questionnaire (Appendix B) will aid the covered individual in the completion of their Medical Surveillance Questionnaire (Appendix C). If the level of exposure is determined to be at a Level 0, Appendix C is not required. Exposure levels at 1 or higher require submission of Appendix B and C. Both Appendix B and Appendix C will be sent to the medical provider for review. This needs to be coordinated with the Office of Safety.

All UND sites in North Dakota will submit the evaluation to the Occupational Healthcare Provider for review. If a medical consultation is recommended for those not living in the Grand Forks area, that exam may take place at the individual's designated medical provider location.

After initial submission, Appendix B and C only need to be completed and re-evaluated by the Occupational Health medical provider if there are changes to the job requirements or position or there is a change in health status.

Appendix B - Health Risk Assessment form

Appendix C - Medical Surveillance Questionnaire form

Following the review of the Occupational Health Risk Assessment Questionnaire (Appendix B) and Medical Surveillance Questionnaire (Appendix C), the health care provider will provide a copy of the Medical Provider Health Assessment Report to UND (Appendix D) to the Office of Safety.

The review will indicate one of the following:

• No Medical Exam/Vaccine is recommended based on the submitted information.
• Recommend Vaccine only: Tetanus, Hepatitis B, Hepatitis A, and Rabies (Based on the Employee/Student Risk Assessment Questionnaire).
• Recommend Medical Exam/Vaccine based on the submitted information.
• Recommend work restrictions
• Recommend no animal contact

All medical records are confidential. 

Appendix D - Medical Provider Health Assessment & Declination form

The principal investigator/supervisor need to update the covered individuals annually utilizing the UND Occupational Health Plan Annual Notification Form (Appendix E).

Appendix E - OHP Annual Notification form

Every UND employee/student who is required to wear respiratory protection must participate in UND's Respiratory Protection Program. The use of any and all types of required respirators at UND is subject to review and approval by Office of Safety prior to use. No employee/student should wear a respirator unless they have completed initial respirator training and, if applicable, have been fit tested.

This includes:

• Full face respirators
• Half mask respirators
• N95 masks