Risk And Emergency Management

NOTICE TO ALL EMPLOYEES WHAT YOU, THE EMPLOYEE, MUST DO IF YOU ARE INJURED AT WORK

Contact your supervisor immediately (24 hours/seven days a week) for any on the job injury, EMS response to a county facility, or when an AED or CPR is employed.

The Supervisor should contact risk ASAP.

Supervisor’s Report of Industrial Injury Form (SRI)

View Form

Report of Exposure Form

View Form

Joe Dorner (call 1st after hours)
(928) 753-0739 ext. 4605
Cell: (928) 279-2226

Jodi Myers
(928) 753-0739 ext. 4172
Cell: (928) 303-1563

Kevin Hartmann
(928) 753-0739 ext. 4068
Cell: (928) 715-0658

You and your supervisor need to complete the Supervisor’s Report of Industrial Injury Form (SRI) above
Email the SRI within 4 hours to Workers Compensation
Notify Risk if the SRI will be delayed. The SRI includes a checklist listing required employee and supervisor action
For a bloodborne pathogens exposure complete the Supervisor’s Report of Industrial Injury Form and the Report of Exposure Form above.

**For an exposure to a bloodborne pathogen, call Risk Management prior to seeking medical care.**

EMERGENCY INSTRUCTIONS: (potential life or limb threatening injury/illness) – CALL 911 or go to an ER. Examples: broken bones, loss of limbs, head/neck injuries, profuse bleeding, seizures, faintness/unconsciousness, breathing difficulties, pain, heat stress symptoms, abnormal heartbeat, and other possible life/limb threatening physical symptoms.

NON-EMERGENCY INSTRUCTIONS: (Non-life or limb threatening injury) - Follow the steps below:

COUNTY EMPLOYEES

Call TriageNow at 1-833-691-9021 for 24/7 advice from a medical professional on appropriate care and whether additional medical facility care is needed. If TriageNow recommends facility care, go to Step 2 below. Your Supervisor is still required to submit an SRI form to the Risk Department.
Go to one of the recommended facilities below or available Urgent Care/ER. Advise medical facility to bill Arizona Counties Insurance Pool (ACIP), 1905 West Washington Street, Suite 200, Phoenix, AZ 85009.

STATE EMPLOYEES (Superior Court, Probation, and Juvenile Detention)

Call Corvel at 1-800-685-2877 for 24/7 advice from a medical professional on appropriate care and whether additional medical facility care is needed. If Corvel recommends facility care, go to Step 2 below. Your Supervisor is still required to submit an SRI form to the Risk Department.
Go to one of the recommended facilities below or an available Urgent Care/ER. Advise the medical facility to bill Corvel Corporation, PO Box 6966, Portland, OR 97228.

YOU MUST NOTIFY YOUR SUPERVISOR IF YOU CHOOSE TO NOT FOLLOW TREATMENT RECOMMENDATIONS.

Kingman

Non-Emergency
KRMC Urgent Care
(928-753-3303)

1726 Beverly Ave.
Kingman, AZ 86401

Emergencies
KRMC Urgent Care
(928-753-3303)

1726 Beverly Ave.
Kingman, AZ 86401

Lake Havasu

Non-Emergency
HRMC Urgent Care
(888-991-3627 or 928-505-1030)

1799 Kiowa Avenue Unit 104 (next to Hobby Lobby)
Lake Havasu City, AZ 86404

Emergencies
Havasu Regional Medical Center
(888-991-3627)

101 Civic Center Lane
Lake Havasu City, AZ 86403

Fort Mohave

Non-Emergency
Valley View Medical Center
(928-788-2273)

5330 South Highway 95
Fort Mohave, AZ 86426

Emergencies
Valley View Medical Center
(928-788-7065)

5330 South Highway 95
Fort Mohave, AZ 86426

Colorado Strip

Non-Emergency
Intermountain WorkMed
(435-251-2630)

385 North, 3050 East
St. George, Utah 84790

Emergencies
Dixie Regional Medical Center
(435-688-4343)

544 South 400 East
St. George, Utah 84770

Bullhead City

Non-Emergency
Western AZ Regional Medical Center
928-763-2273)

2735 Silver Creek Road
Bullhead City, AZ 86442

Emergencies
Western AZ Regional Medical Center
(928-763-2273)

2735 Silver Creek Road
Bullhead City, AZ 86442

Director

Joe Dorner

Office Hours:
Mon-Fri 8:00 A.M. - 5:00 P.M.
Closed on County designated holidays

Phone:
(928) 753-0739

Email:
Contact Us

Address:
700 West Beale Street
Kingman, Arizona
86401

Risk And Emergency Management

Sign up for news alerts