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Staff Safety Resources

Workers’ Compensation can be a challenging concept to manage and understand. However, understanding the District’s workers’ compensation program is imperative in order to clearly identify your role in the reporting process and receive the appropriate treatment. Collective feedback that’s been given such as your questions, comments, and concerns related to potentially identifiable/unidentifiable hazards inspired us to create the Workers’ Comp Reference Guide. This page will be used as a quick reference to most of your workers’ compensation needs that will define key terms as well as provide an insight on utilizing and managing the reporting process. Thank you in advance for your support, appreciation, and cooperation in the implementation process that will enable the district to reduce work related injuries and make us a safer district. Hope this helps!

Workers' Compensation Forms

Supervisor's Report of Work Related Injury

Employee Incident Checklist

Employee Injury/Incident Form


Physician Locator

Waiver of Treatment

Completed forms/documents should be returned as soon as possible to:

Shelby Fields, Risk Manager
165 N. Columbus Ave.
Mount Vernon, NY 10553
Phone: (914) 665-5136

Valrie Wright

Contact Info

Office of Risk Management
165 N. Columbus Avenue
Mount Vernon, NY 10550

Shelby Fields
Risk Manager
(914) 665-5136

Valrie Wright