Quil Ceda Village Health and Safety

Immediately report your injury to your supervisor and pick up an Injury Packet from the Office of Health and Safety. Contact Matt Humphreys Safety Officer For Q.C.V @ 360-716-5067 or Dean Henry Safety Officer Tulalip Tribes @ 360-716-4439.

Seek medical attention.
IMPORTANT: Your employer/Tribal First reserves the right to direct your care to a provider of their choice. Please check with your employer, before seeking medical attention, to verify whether or not a provider has already been selected.

Have the attending physician complete the Physicians Initial Report included in this packet. You may leave this form with your physician, and he/she will forward it to the insurance company listed on the form, or return it to the Office of Health and Safety. Your attending physician should also complete the Return to Work Authorization form. This form needs to be returned to the Office of Health and Safety to be forwarded to Tribal First with your Accident Report.

Complete the upper portion of the Accident Report included in this packet. This should be completed within two days of the injury. Return the completed form to the Office of Health and Safety. Human Resources will complete the bottom portion of the accident report. The Office of Health and Safety will then forward it to Tribal First.

As soon as Tribal First receives your completed accident report, your claim will be processed and a claim number assigned. If Tribal First does not receive a completed form, time loss or medical benefits cannot be provided.