For all life threatening injuries, dial 911. In the case of death or serious injury, contact the Benefits Office immediately.
When an employee sustains ANY work-related injury or illness, no matter how minor (bumps on the head, cuts, trip and falls, strains, etc.) he/she must report it immediately to their Manager/Supervisor. If a Manager/Supervisor is unavailable, it is the responsibility of the employee to report the injury to the Benefits Office. Failure to report injuries in a timely manner, could result in further risk to the employee and/or create a liability for the District.
Employees must also contact the Company Nurse Injury Hotline at (877) 518-6702. Company Nurse provides District employees with 24/7 telephone access to Registered Nurses and medical professionals. Company Nurse may refer the employee to an Occupational Medical Facility to be evaluated.
Following the District’s knowledge of the injury/illness and within 24-hours, the employee must be provided a Workers’ Compensation Claim Form (DWC 1) to be completed, signed and returned by the employee to the Benefits Office. Completed claim forms must be received by Keenan & Associates within 5-days of the accident or incident.
When an injury occurs, please provide the injured employee with the following documents:
- Workers’ Compensation Procedure
- Company Nurse Injury Hotline
- Workers’ Compensation Claim Form (DWC1) (Manager completes questions 12–14 and 17–19 and provides to employee. Employee completes questions 1-9 and returns to the Benefits office)
- PRIME Advantage MPM Complete Written Employee Notification
MANAGER or SUPERVISOR
The Manager or Supervisor should complete the following and return to the Benefits Office within 5 days from the date of injury:
- Supervisor’s Report of Employee Incident or Injury
- Supervisor’s Supplemental Questionnaire
- Questionable Workers’ Compensation Injury Information (if applicable)
Contact Ron Owen, Senior Benefits Analyst, with any questions at firstname.lastname@example.org or (415) 457-8811, ext. 8159.
If you wish to designate a personal physician to treat you in the event of a workers’ compensation injury, please complete the Physician Pre-Designation form. This form must be signed by you AND your personal physician and submitted to the Benefits Office, BEFORE an injury occurs, to be valid.