Report a Work Related Injury or Illness - for Supervisors
Incidents must be reported within 24 hours of University’s first notice of incident so that prompt and appropriate remediation can take place. Always report an incident, no matter how small.
If your employee is injured or develops a job-related illness as a result of employment at UC Merced, get medical attention for the employee and complete the required workers' compensation forms.
Call 911 in event of medical emergency when employee life or limb is threatened
If an Injury or Illness Occurs
- Give the Incident Report to employee to complete the “Employee Information” section of the form and return it to you to complete the “Supervisor” section, even if the employee doesn't intend to seek medical treatment.
- Email the completed Incident Report to the Workers’ Compensation Office and Environmental Health & Safety within 24 hours of knowledge of the Incident.
- If the employee is unable to complete or sign the form, you or a department representative must complete it on their behalf.
- You can also report the injury/illness by calling the 1-800 Workers’ Compensation Claim Reporting Hotline (1-877-682-7778). This is a National Intake Center that is utilized by UC systemwide and operates 24 hours a day, 365 days a year. Once an injury is reported to the National Intake Center, the center will send an email to the Workers’ Compensation office within 24 hours of the call.
If Medical Treatment is Sought
- You must contact the Workers’ Compensation office 209-259-8806 for authorization for employee’s medical treatment at one of the UC Merced designated occupational health facilities.
- In addition to the Incident Report, ensure that the employee completes and signs the employee portion of the DWC-1 Claim Form and gives the form to you for further completion. Forward the completed form to the Workers' Compensation Office.
- If employee has a signed pre-designated physician form on file prior to the injury/illness, refer the employee to their designated physician. If not, the employee may go to a designated occupational health facility for treatment.
- If you are not available, the employee may contact an alternate department representative or the Workers’ Compensation office 209-259-8806 for authorization. After normal business hours, the employee may go directly to one of the designated occupational health facilities.
- Worker fatality
- Inpatient hospitalization more than 24 hours
- Loss of any body part (e.g., fingertip)
- Serious injury
These incidents must be reported to OSHA within 8 hours of the event.
Time Off Work
- The employee must bring a doctor's note to you describing the treatment received and work status. You must email a copy to the Workers’ Compensation Office and Environmental Health & Safety (EH&S)
- Written authorization from the medical provider is required if the medical provider extends the period of time off work.
- Written authorization from the medical provider is required prior to employee returning to work.
If employee loses time from work or requires ongoing treatment, you should:
- Follow up with employee continuously on medical treatments
- Forward all medical notes to the Workers’ Compensation office.
- If the employee is out for more than 3 continuous working days, contact Human Resources to request a Family Medical Leave (FMLA) packet.
- Work with the Disability Specialist on a transitional return to work agreement during the employee’s recovery period.
Questions? Contact firstname.lastname@example.org or 209-259-8806