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
• Formulario Para Eleccion De La Compensacion De Los Trajadores -Workers' Compensation ESL Election- Spanish
• Facts About Workers' Compensation pamphlet and Predesignation of Personal Physician Form
• Predesignation of Personal Physician Form- Workers' Compensation
• Informacion Acerca de la Compensacion de Trabajadores -Facts About Workers' Comp pamphlet-Spanish
• Workers' Compensation Mileage Reimbursement 2023

For Questions

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