• Skip to main content
  • Skip to main navigation
UC Santa Cruz
  • MyUCSC
  • People
  • Calendars
  • Maps
  • A-Z Index

Risk Services

  • About
  • Initiatives & Programs
  • Insurance & Claims
  • Workers' Compensation
    • Workers' Compensation
    • COVID-19
    • Return-to-Work Program
    • WorkStrong Program
    • Volunteers
    • Workers' Comp Forms
    • Be Smart About Safety (BSAS)
  • Faculty & Staff Wellness
  • Quick Links
    • Certificate of Self-Insurance
    • Contracts
    • Forms
    • Report a Claim
    • Report an Injury - Workers' Compensation
    • Risk Assessment
    • Volunteers
    • Waivers

Home / Workers Comp / Workers' Comp Forms

● Workers' Compensation Forms

Workers' Compensation Forms, for assistance please contact the Workers’ Compensation office in Risk Services at (831) 459-1787 or (831) 459-2850.
  • Employer's First Report of Injury (EFR)
    • Click on "Login" and then log in with your CruzID and Gold Password to access the online form. Click on "Create Claim."
  • Employee Authorization for Medical Treatment of Occupational Incidents
  • Volunteer Waiver and Election of Workers' Compensation
  • Pharmacy Benefit - Workers' Compensation Prescription Program
  • Beneficios Farmaceuticos - Workers' Compensation Prescription Program- Spanish
  • Workers' Compensation ESL Election Form & Instructions
  • Facts About Workers' Compensation pamphlet
  • Informacion Acerca de la Compensacion de Trabajadores -Facts About Workers' Comp pamphlet-Spanish

 

  • Workers' Compensation
  • ● Injury Reporting & Medical Treatment
  • ● Designated Medical Treatment Providers
  • Workers' Comp Forms
  • Transitional Return to Work
  • WorkStrong Program
University of California
UC Santa Cruz, 1156 High Street, Santa Cruz, Ca 95064
©2021 Regents of the University of California. All Rights Reserved.
Office of the President Risk Services Staff Directory Feedback
  • Accreditation
  • Non-Discrimination Policy
  • Land Acknowledgement
  • Employment
  • Privacy Policy & Terms of Use
  • Sexual Violence Prevention & Response (Title IX)

Last modified: February 26, 2021 128.114.113.73