Injury Reporting & Medical Treatment

HOW TO REPORT WORK-RELATED INJURIES 

If you have sustained an injury or illness due to and in the course of work, please follow the guidelines below to file for worker's compensation.

	Call 9-1-1 for medical emergencies.
	For any work-related death or serious injury or illness (loss of body part, permanent disfigurement, or inpatient hospitalization greater than 24 hrs for other than observation) call 9-1-1, then immediately after, call the Office of Risk Services, Workers' Compensation at (831) 459-1787.
	If an employee has sustained an injury at work during the course of work, the injured employee reports the injury to their supervisor.
	Either the supervisor or employee complete the Employee Injury & Illness Reporting claim form* within 24 hours, the EFR automatically submits to Office of Risk Services, Workers' Compensation. The Investigation Information section should be completed within 72 hours from the date the incident was reported by the supervisor. For assistance, please contact Workers’ Compensation (831) 459-1787 or (831) 459-2850. Please Note: A Record Only is informational only, to seek medical treatment indicate Medical Treatment Outpatient Treatment on the Employer's First Report of Injury.
	If the employee requests medical treatment, the supervisor must complete the Employee Authorization for Medical Treatment of Occupational Incidents form and provide it to the employee to seek medical care.
	The employee must then provide the printed form to the medical provider (please note that the medical provider doesn't accept electronic forms). For any questions regarding the Employee Authorization for Medical Treatment of Occupational Incidents form or the medical treatment process, please contact the Office of Risk Services, Workers' Compensation at (831) 459-1787 or (831) 459-2850.

SHARPS INJURY LOG FORM

• For information view UCSC Bloodborne Pathogens Program 
• A Sharps Injury is a penetrating stab wound, including, but not limited to, needle devices, scalpels, lancets, broken glass, broken capillary tubes, exposed ends of dental wires and dental knives, drills and burs that may result in exposure to blood or other body fluids.
• Log onto the Employee Injury & Illness Reporting
• Indicate if it is a Record Only or a Workers' Compensation Claim 
• A Record Only is informational only, to seek medical treatment indicate Medical Treatment Outpatient Treatment on the Employer's First Report of Injury.

For Questions

Contact Cindy Delgado at cadelgad@ucsc.edu or 831-459-1787.