Incident Reporting Guidelines
Incidents must be reported withing 48 hours of your knowledge of the event so that prompt and appropriate remediation can take place.
If an Injury Occurs
- Employees should report an occupational injury to their supervisor immediately and seek medical care when necessary.
- Supervisors must provide an injured employee with an Incident Report Form within one business day of learning of the injury.
- The employee must complete the “Employee Information” section.
- The supervisor must complete the "Supervisor" section.
- Fax the completed Incident Report Form to the Workers’ Compensation Office and Environmental Health & Safety (EH&S) or email to: firstname.lastname@example.org. Please provide a copy of the completed form to the employee.
- An injury can also be reported by calling the 1-800 Workers’ Compensation Claim Reporting Hotline (1-877-682-7778). This is a National Intake Center that is utilized by UC systemwide. This National Intake Center operates 24 hours a day, 365 days a year. Once an injury is reported to the National Intake Center, the center will send an e-mail to the Workers’ Compensation office within 24 hours of the call.
If Medical Treatment is Sought
- An employee who suffered from an occupational injury and needs medical treatment should be referred to one of the facilities that are authorized to provide medical care unless the employee has completed a Designation of Personal Physician Form (English / Spanish) prior to the injury.
- The employee will need to bring a doctor's note describing the treatment received and work status to the department.
- Keep a copy of all of the doctor's notes and correspondence for departmental files.
- The department will need to fax/send a copy to the Workers’ Compensation Office.
Note: If an accident results in an employee being hospitalized, other than for observation, for 24 hours or more, or a loss of a limb (amputation) or loss of life, notify the Workers’ Compensation Office and EH&S immediately. EH&S must report these types of accidents to OSHA within 8 hours of the event.
- The employee should notify their supervisor prior to going to a doctor and any physical therapy appointments, and keep their supervisor informed on the status of their injury/claim.
- Always send the doctor’s notes and correspondence to the Workers’ Compensation Office.
- If the employee pays or receives a bill, forward the bill or receipt to the Workers’ Compensation Office.
- When the treating physician releases an employee with a work restriction, the supervisor should contact the Disability Management Coordinator to discuss the transitional return to work.
- If the injury / illness involves a loss of days, and the leave qualifies as Family Medical Leave (FML), the supervisor should provide an FML notice and paperwork within 3 business days along with the Sick / Vacation Leave Authorization Letter.
- Please read the Workers’ Compensation Policy: Campus Policy Number 600-85 for a thorough description of process and procedures.