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Worker’s Comp Information

In the event you have had an incident requiring professional medical care (Urgent Care, ER, 911, etc.) during the course of work, please fill out the Worker’s Compensation packet below. This packet should be completed and submitted to your building’s office as soon as possible.

Contact your building’s office manager or administrators after such an incident has occurred. If you have any additional questions or concerns, contact luke.chicquaye@albany.k12.or.us, or call 541-967-4505 ext. 3309.

Worker’s Compensation Packet

Per Section 8.5 of the GAPS Classified Agreement, the District will provide compensation up to $500 per incident for loss or damage of employee’s prescription eyeglasses due to student behavior. This compensation will be provided with or without the employee turning in a claim to their insurance. The District may investigate an incident to determine the loss was due to student behavior and not negligence or inappropriate behavior.

Please complete the form as well as print and sign below, and attach the related invoice(s) or receipts for the replacement items being requested. Submit this form and paperwork to the District Safety Officer at the District Office.

Eyeglasses Reimbursement Form