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Workers' Compensation

Supervisor's Guideline

The following procedures must be followed by the supervisor when a work-related illness or injury has occurred in the work place.

1. Arrange for appropriate medical treatment for the employee.

  • Emergency Medical: Dial 911 from a campus phone, and request an ambulance to transport the employee to St. Agnes Hospital.
    • Immediately contact Risk Management at 278-7422 (or Campus Police Department after hours) to report the injury.
    • NOTE: Cal-OSHA requires notification within 8 hours of hospital admissions and serious injuries. Once you have contacted Risk Management, Risk Management will contact OSHA on your behalf. Fines associated with NOT reporting the injury as required will be the responsibility of the employee's department.
  • First Aid: Refer the employee to the University Student Health Center.
    • Examples of First Aid injuries include: minor cuts, scrapes, sprains and bruises.
  • Medical Treatment beyond First Aid: Contact the Workers' Compensation Manager, Julie Irwin at 278-2125 to obtain authorization to send the employee to the Occupational Health Center at St. Agnes.

2. Contact Julie Irwin, Workers' Compensation Manager, 278-2125 to report the injury, and provide updates regarding the employee's work status.

  • Report the injury as soon as possible.
    • Serious injuries and illnesses must be reported to Cal-OSHA within 8-hours, regardless of the day or time the Supervisor was notified. After hours, contact Campus Police to report the injury.

  • Keep the Workers' Compensation Manager informed of all updates to the employee's work status, including: off duty status, releases to light and full duty work.
    • Provide the Workers' Compensation Manager with copies of all reports and notes from the treating physician(s).

3. Complete the Supervisor Report Form

  • Fax a copy to Julie Irwin at 278-6995 as soon as possible, but no later than 24 hours from the date the injury is reported to the Supervisor. Julie will send the employee the DWC1 form after the injury is reported by the Supervisor.
  • Provide a copy to the employee, with instructions to take it to the University Student Health Center when seeking first aid treatment.


Supervisor Report of Injury Form