INJURY REPORTING

When an employee is injured on the job . . .   

¨      Refer the employee to Occupational Health Facility (OHF) or UCLA Emergency Medicine Center (EMC) for TREATMENT. 

¨      Provide the employee with:

1.      A completed EMPLOYEE’S CLAIM FORM FOR WORKERS’ COMPENSATION BENEFITS

         This form must be provided within 24 hours of receipt of notice that an injury or illness has occurred as mandated by California State law.  (exception: First Aid incidents)

2.      A completed EMPLOYEE’S REFERRAL SLIP FOR INDUSTRIAL INJURY AND REPORT OF ACCIDENT

3.      UCLA Healthcare Workers’ Compensation Pamphlet When An Injury Occurs & Workers’ Comp Information Sheet

¨      NOTIFY Healthcare Human Resources Workers’ Compensation x40500 as soon as you are aware that an employee has been taken off work.

¨      NOTIFY your Department Personnel/Payroll representative to begin appropriate payroll process.