Reporting an On-the-Job Injury/Illness
If you experienced an on-the-job injury or illness, you are to report the incident immediately to your supervisor no matter how minor. Once the injury is reported, an incident investigation will occur to determine the cause of the incident and corrective action taken to prevent the incident from reoccurring. Please note: Failure to report an injury could result in the denial of your claim.
The Worker’s Compensation program provides benefits to any employee who suffers disability through accident or occupational disease arising out of, and in the course of employment, according to the provisions of the State of California Workers’ Compensation Act. This act applies to all University Employees, whether full-time, part-time, or temporary.
Injury & Illness (Report work-related injury/illness with the form below):
- Injury & Illness Report
- Workers Compensation Claim DWC 1 (must be completed within 24 hours of incident and submitted to Human Resources within 48 hours of incident--see brochure above for full details)
- Form 5020 (Employer's Report of Occupational Injury or Illness)
Dell Jean Van Fossen