Clover Park School District is committed to providing access to all individuals seeking information on our website.
If you have any issues with the district website accessibility or are having difficulties accessing the site please email firstname.lastname@example.org and include the following information:
The nature of your accessibility or alternative format needs
The URL (web address) of the material you would like to access
Your contact information
We will contact you to attempt to provide the information you are trying to access and will seek to resolve any issues regarding inaccessibility on the site.
If you would like to share concerns or file a complaint regarding the accessibility of CPSD’s website for persons with disabilities, please contact the Title IX Officer and Section 504/ADA Coordinator at Clover Park:
Title IX Officer and Section 504/ADA Coordinator Director
Mail: 10903 Gravelly Lake Drive SW, Lakewood WA 98499
This page is designed to help Clover Park School District employees go through the process of documenting and filing a claim for an on the job injury. Answer the question below to begin.
Did you or will you seek medical treatment?
* If you seek medical care at a Military Treatment Facility such as Madigan Army Hospital you MUST take the below forms with you. These are required by Washington L&I to process your claim. Military Treatment Facilities do not provide these forms for you. Failure to have these forms completed and signed will slow your claims process significantly or even cause claim denial.
EMPLOYEE RESPONSIBILITY: Immediately notify your supervisor of the event. Complete an employee accident/incident report (SEE Below). In addition, you must file a workers compensation claim online as soon as you are able.
Upon completion of your online claim, you will be issued a claim number to give to your medical provided.
If you are not released to return to work, you are responsible to update your supervisor and risk management by providing copies of all doctor notes, submitting absence slips and phoning in with weekly progress updates.
EMPLOYEE RESPONSIBILITY: Immediately notify your supervisor of the event, and complete required documents (SEE Below) withing one (1) business day.
Accident Report. Within one business day of the event, complete and sign only the employee section. Make a copy for your records.
Submit the completed Accident Report to you supervisor to complete and forward to the district risk management office.
NOTE: You may change your mind and seek medical treatment. If you choose to do so, notify your supervisor and risk management; then click the "Yes" button to the Did you or will you seek medical treat question at the top of the page.
SUPERVISOR RESPONSIBLITY: Notify and document
PURPOSE: Required reporting and accident prevention. Immediately notify the district risk management office when anyone reports an injury or accident
Accident Report. After an employee completes the top section, the supervisor completes and signs the supervisor's section (lower portion).
Submit the completed Accident Report to the risk management office within two business days of the event.
NOTE: Clover Park School District is a self-insured employer under Washington state law. The physician must use the self-insured accident report and do not complete state L & I paperwork.
The medical provider will then submit all required paperwork directly to Puget Sound Worker Compensation Trust.
Claims are processed by: Puget Sound Workers Compensation Trust
800 Oakesdale Avenue SW, Renton, WA 98057
Questions can be direct to:
Risk Management Office, Clover Park S.D.
10903 Gravelly Lake Dr. SW, Lakewood, WA 98499
Phone: (253) 583-7357 Fax:(253) 583-5018