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Disability benefits program - Northeastern University 2026
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- Click ‘Get Form’ to open the Workers’ Compensation Accident/Illness/Near Miss Report Form in the editor.
- In Part A, enter your personal information including your name, employee ID, date of birth, and home address. Ensure all fields are filled out accurately.
- Provide details about the accident or near miss in the description section. If necessary, attach a separate sheet for additional information.
- Sign and date the form at the bottom of Part A to confirm your statement is complete and accurate.
- Part B must be completed by your supervisor. Ensure they discuss the incident with you before filling it out.
- If medical treatment was received, ensure that a work clearance note is attached before submitting the form.
- Submit the completed form via email to insurance@northeastern.edu or deliver it to the Office of Risk Services within 24 hours of the incident.
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Related links
Oct 12, 2022 Northeastern University, Boston, Massachusetts 02215,. United States Agent Orange exposure and. VA disability compensation. httpsRead more
Jan 1, 2012 The maximum monthly benefit you may receive, including all of the above sources, is. 60% of your monthly salary up to $25,000 maximum. Page 3Read more