This information is provided specifically for managers and supervisors to help them take required actions when one of their employees is injured at work.

A more general overview of the Worker's Compensation program is available at the following link, Facts About Worker's Compensation.

Procedures for Work-Related Injuries and Illnesses:

When University employees are injured or become ill as a result of work-related activities, they are entitled to Workers' Compensation benefits, provided the employee and supervisor comply with certain procedures. The following procedures are designed to assist supervisors and/or administrators when work-related injuries or illnesses occur. Failure to follow these procedures may delay or jeopardize the employees' benefits and create unnecessary costs for the University. If you have any questions after reviewing the procedures contact the campus Workers' Compensation Specialist at ext. 2623.

When a work-related injury occurs:

EMERGENCIES - For emergency assistance call - 911

If a serious injury or illness occurs immediately call Campus Police by dialing 911. Give your name, describe the nature and severity of the medical problem, and the campus location of the victim. Campus police will provide immediate medical attention and will arrange for transportation if necessary.

Minor Injuries - If the injury is minor an employee trained in first aid may administer first aid. Administration of first aid should be documented in a departmental first aid log. Our campus police are well trained can be helpful with administering First Aid and determining if further medical attention is needed. The police may be called at campus extension 8444 or 911.

If the injury is not a medical emergency but requires medical attention do the following:

  • Provide the employee with an authorization for Medical Treatment (for treatment at U.S. Healthworks). Authorization forms are available in your department or from Human Resources.
  • Send the injured employee to U.S. Healthworks. If the employee is incapable of driving himself or herself to the medical facility, Campus Public Safety or the employee's emergency contact should be called upon to provide transportation.
  • Employees sustaining minor injuries will be sent to U.S. Healthworks. Those sustaining more serious injuries should be transported to the closest facility that can provide the most immediate care. Public Safety will assist with making this determination.
  • As soon as the injured employee's immediate needs are met provide them with a form entitled "Worker's Compensation Claim" (form is available from Human Resources). Upon completion of the claim form, provide the employee with the Temporary Receipt copy (last page). Directions for the completion of this form may be found below.
  • Prepare the Supervisor's Injury or Illness Report.

When an accident or injury occurs, a thorough investigation of the incident is required in order to determine the following:

  • Any unsafe work conditions requiring corrective actions
  • Any unsafe work practices requiring training or follow up
  • Compensability of Workers' Compensation claim and benefit entitlement

In order to complete the form several actions are normally required:

  • Inspect the accident site
  • Interview all witnesses
  • Note any other factors that may have contributed to the injury
  • Determine if further corrective action is required (e.g. training, physical correction, process change etc.)
  • Identify corrective actions already taken

Forward the completed Claim Form and Supervisor's Injury or Illness Report o the Workers' Compensation Specialist in Human Resources. These forms should be submitted within one working day (24 hours), and may be faxed to 805-437-8491.

Immediately report any safety hazards to the Environment/Safety/Risk office, ext. 8847.

Inform staff of any corrective actions to be implemented at the work site or safety practices to follow as a result of the investigation.

If the employee feels the injury is not serious enough to warrant medical attention or a claim, it is recommended the supervisor still document the incident. Prepare a Supervisor's Injury or Illness Report, and check the 'Documentation Only' box at the top of the report form. A copy must be sent to Human Resources.

Injuries for which the employee should be encouraged to seek medical evaluation include (but are not limited to):

  • Orthopedic injuries (especially back/knee injuries)
  • Cumulative trauma injuries (ex: carpal tunnel syndrome)
  • Head injuries
  • An injury resulting in loss of consciousness or ambulation
  • Exposure to possible hazardous substances

If the employee requests to see a physician at a later date, please notify the Workers' Compensation Specialist in Human Resources immediately.

Employees have one year from their date of injury to seek medical treatment.

While Your Employee is Off Work

Make contact with your employee when you become aware that they will be off work and maintain contact so that you will always be aware of and involved with his or her health status and estimated return to work date.

Notify the Campus Workers' Compensation Specialist of the employee's anticipated return to work date. You must have a work status report releasing the employee to return to work from the appropriate treating physician before the employee can resume his or her job duties.

When Your Employee Returns from the Physician

The physician will give the employee a work status form which must be turned in to his/her supervisor. This form will indicate if the employee can return to work, and if so, if there are limitations or work restrictions.


If the work status report indicates the employee should not be working DO NOT permit your employee to resume work. The employee should be sent home. Do not permit the employee to take work home.

If the work status report indicates the employee can return to work without limitations, allow the employee to resume working.

If the work status report indicates the employee can return to work with limitations you will be involved in the employee's recovery by developing transitional work. This transitional work is developed through knowledge of the employee's work restrictions and a determination if we can provide job modifications required to comply with those restrictions. For more information see the following link: Return-to-Work and Transitional Work Plans.

Send or fax a copy of the work status report to Human Resources. If the employee is unable to resume working and must lose time, notify the Workers' Compensation Specialist (ext. 2623) immediately.

Directions for Completing the Workers Compensation Claim Form

The Employee's Claim for Workers' Compensation Benefits form should be given to all employees who intend to seek medical care. If the employee is treated by a medical facility or they request a claim form, the Worker's Compensation Claim form must be provided to the employee within 24 hours of the injury or request. If the employee is off campus, mail the form via certified mail with a cover letter. Provide a copy of the cover letter to our Worker's Compensation Specialist in Human Resources.

Employee Section

Review the following areas to ensure the employee has completed the form correctly:

  • The date of injury, or the date the employee knew the injury or illness was job related.
  • The place where the injury occurred, please ask the employee to indicate the exact location on campus.
  • The description of the injury or illness; ask the employee to provide a complete description of the injury including the activity in which the employee was
  • engaged in at the time of injury and what specific parts of the body are involved.
  • Do not complete the employee section for the employee unless he or she is unable to do so. The claim form is a legal document providing the injured employee an opportunity to state what has occurred.

Employer Section

Pay special attention to the following areas:

  • The date the employer first knew of the injury or illness; this is the day the employee first notified you the injury or illness was job related*.
  • Date you provided the employee a claim form**.
  • Date employer received the completed claim form is the date the employee gave back the form.
  • Signature of Employer Representative can be provided by a designated manager in the department.

* Date of knowledge: An employee may complain of an injury or illness to a supervisor or co-worker for some time before indicating to anyone the cause of the injury or illness was job related. The date the supervisor knew of the injury is the date he/she learned the injury was caused by the job.

** Date form was provided: The law states the employer must provide the claim form to the employee within one working day of the date of knowledge. In most cases this is 24 hours. If the employee notifies the supervisor on a Friday and neither employee is scheduled to work the weekend, then Monday would be the next working day. If the claim form is not provided to the employee within one working day, a memo must accompany the claim form when sending to Human Resources indicating the reason for delay. Be aware that failure to meet this regulation could result in fines against the University.