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.
UCLA Occupational Health (OH) - 10833 Le Conte Avenue,17-240 Center for Health Sciences (CHS)
7:30 a.m. to 4:30 p.m. Monday - Friday
After OH Hours use Ronald Reagan UCLA Medical Center Emergency Room
757 Westwood Plaza (ER entrance Gayley Ave, north of Le Conte)
OFF-CAMPUS EMPLOYEES = MORE THAN 30 MINUTE TRAVEL TIME FROM UCLA CAMPUS
If the injured employee works at an off-campus location more than 30 minutes from UCLA Occupational Health, 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: OH Clinic Partners
2. Complete the Injury Reporting Process Within 24 Hours of Notice of Injury
*UCLA Single Sign On – ID & Password
*Web Browser must be Firefox or Google Chrome (Not compatible with Internet Explorer)
*Employee must be in UCPath. This system cannot be used for volunteers.
If completing the Incident Report & Referral form, Employee and Supervisor complete and sign the top two sections. Send the form with the employee to present 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:
- The Employee complete sections 1-9.
- The Supervisor completes the bottom sections 12-14 and 17-19.
- Give the Employee a completed-signed copy.
- Send the original form to your HR (Human Resources)/Payroll/Personnel representative.
Additional Information for Employees, Visitors, and Volunteers
Employees who have already filed a claim should contact Sedgwick CMS, the University's third party administrator for Workers' Compensation. When an injury is reported, Sedgwick CMS determines eligibility and administers all benefits accordingly.
For general questions, contact the UCLA Campus Workers' Compensation Program Manager or UCLA Campus Workers' Compensation Program Analyst.
See the related articles for information regarding injuries to visitors, students and volunteers.
UCLA Campus Workers' Compensation Program Analyst: (310) 794-6952
UCLA Campus Workers' Compensation Program Manager: (310) 794-6954
UCLA Campus Employee Disability Management: (310) 794-6948 select option 2
Claim Report line: (877) 682-7778