What To Do When There Is An Injury At Work

1. Get the Injured Employee Medical Attention

Severe Injuries call 911*

Severe injuries and/or hospitalized requires an immediate call to Environment Health & Safety Hotline at (310) 825-9797.

OHF at 17-240 Center for Health Sciences at 10833 Le Conte Avenue. Call (310) 825-6771

7:30 a.m. to 4:30 p.m. Monday - Friday

After OHF Hours use Ronald Reagan Emergency Room

757 Westwood Plaza (ER entrance Gayley Ave, north of Le Conte)

OFF-CAMPUS EMPLOYEES = MORE THAN 30-MINUTES TRAVEL TIME FROM UCLA CAMPUS

If the injured employee works at an off-campus location that would take more than 30 minutes to get to the UCLA Occupational Health Facility, then the employee may be seen at an Occupational Health Clinic Partner.  A list of Occupational Health Clinic Partners is located at the following link: OHF Clinic Partners

2. Complete the Injury Reporting Process Within 24-Hours of Notice of Injury

Complete this via the Electronic First Report (EFR) System. In order to use EFR, the following is required:

      *UCLA Single Sign On – ID & Password

      *Web Browser must be Firefox or Google Chrome  (Not compatible with Internet Explorer)

      *Employee must be in the employee database (EDB). This system cannot be used for volunteers


If you are unable to access EFR, then complete this Incident Report & Referral form and submit a copy to: wcreports@irm.ucla.edu


If completing the Incident Report & Referral form, Employee and Supervisor complete and sign the top two sections. Send the form with the employee to give to the medical provider.

Please try to accommodate your employee's temporary work restrictions if any. If you have questions contact Employee Disability Management via e-mail at: RTWmail@irm.ucla.edu or call (310) 794-6948 and select option 2. For further information use the staff resources directory.

3. If the Injury is more than First Aid, Give the Employee:

a) The Employee complete sections 1-9. 

b) The Supervisor completes the bottom sections 12-14 and 17-19.

c) Give the Employee a completed-signed copy.

d) Send the original form to your HR (Human Resources)/Payroll/Personnel representative.

2) When an Injury Occurs Pamphlet

Additional Information for Employees, Visitors, and Volunteers

Employees who have already filed a claim should call Sedgwick/CMS, the University's third-party administrator for Workers' Compensation. When an injury is reported, Sedgwick/CMS assigns the claim to an administrator who determines eligibility and administers the benefits accordingly.

For general questions, contact the Workers' Compensation Program Manager or Workers' Compensation Program Analyst.
See the related articles for information on visitor, student and volunteer injuries.

Contact Information

 Workers' Compensation Program Analyst: (310) 794-6952

 Workers' Compensation Program Manager: (310) 794-6954

 Employee Disability Management: (310) 794-6948 select option 2

 Claim Report line: (877) 682-7778

UCPath Workers’ Compensation Leave Instructions – Employee Off Work For A Work Related Injury

  1. In order for the employee to be paid properly by UCPath, the employee must select an option per the Workers’ Compensation Election Form. 
    • Workers' Compensation Election  
    • Workers' Compensation Instruction  
    • The employee can choose one of the following:
      • Option 1: Use sick and vacation leave to supplement temporary disability checks from Sedgwick for 100% of their pay.
      • Option 2: Use only sick leave (not vacation) to supplement temporary disability checks from Sedgwick for 100% of their pay.
      • Option 3: No use of leave accruals to supplement temporary disability checks from Sedgwick that provides for 66 2/3% of their wages.
  2. Department personnel must provide the Workers’ Compensation Election form to the employee within 24 hours of notice that an employee is off work due to their injury and discuss the options above with said employee.  Notice must be sent via trackable method (email is acceptable).
  3. The employee completes the Worker’s Compensation Election form and sends completed form to UCPath within 5 business days of being placed on workers’ compensation leave and gives a copy to their Department.  UCPath contact information is listed below.  If this form is not received by UCPath within this time frame, UCPath will elect Option 2 as the default on the employee’s behalf (supplement using sick time accruals only).
  4. Department personnel emails a copy of this completed form to wcreports@irm.ucla.edu.
  5. Department personnel enters a new leave transaction into UCPath.  If the employee chooses option 1 or 2 AND has no accrual balances, then leave should be coded as Extended Sick Leave.  Extended Sick Leave exhausts after 26 weeks/182 days.  For instruction on entering leave transactions into UCPath, please reference UCPath training materials or contact UCPath (see below).

UCPath Contact Information
UCPath: http://ucpath.universityofcalifornia.edu
UCPath Center email: ucpath@universityofcalifornia.edu


UCPath Center
14350-1 Meridian Parkway
Riverside, CA 92518
Phone: (855) 982-7284
Fax: (855) 982-2329
Monday - Friday: 8a.m. – 5 p.m.


IRM Contact Information
 Workers' Compensation Program Manager: (310) 794-6954
 Workers' Compensation Program Analyst: (310) 794-6952