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.