Employee Injury & Illness Forms

If a work related injury/illness occurs……

  • Report the injury/illness to your supervisor/manager within 8 hours
  • Contact the Workers’ Compensation Coordinator (WCC)
  • Seek medical attention, if needed
  • Complete Employee Injury/Illness forms

Reporting an injury/illness to your Manager/Supervisor

You must report any injury or illness to your manager/supervisor within eight (8) hours, no matter how trivial the injury may seem.  You will need to inform your manager/supervisor when and where the injury/illness occurred, what happened, and if anyone witnessed the injury.  Prompt reporting of an injury/illness will help prevent problems and delays in receiving benefits, including medical care you may need to avoid further injury.

Employee Injury/Illness Report

State of California Workers’ Compensation Claim Form (DWC1)

Workers’ Compensation Employee’s Responsibility

Return to Work Employee Information Sheet

Industrial Disability Plan Fact Sheet

Guide for Employees

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