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What to Do When an Injury Occurs

Get the employee medical attention. If the injury is severe call 911.  Send the employee to OHF/Emergency Medicine or use a first aid kit depending on the severity of the injury.  The employee and supervisor must complete the Incident Report and Referral for Medical Treatment form to insure OHF will treat the injury. The employee must bring back to their department the Incident Report form  signed by OHF.The department must fax a copy of the completed referral form to OIRM to insure the employee gets Workers' Compensation benefits. Get the employee medical attention.If the injury is severe call 911. Send the employee to OHF/Emergency Medicine or use a first aid kit depending on the severity of the injury. The employee and supervisor must complete the Incident Report and Referral for Medical Treatment form to insure OHF will treat the injury. The employee must bring back to their department the Incident Report form  signed by OHF.The department must fax a copy of the completed referral form to OIRM to insure the employee gets Workers' Compensation benefits.

1. Get the injured employee medical attention

  • For severe injuries call 911
  • For on-campus injuries, contact:
    • Occupational Health Facility (OHF) 
      Location: 200 UCLA Medical Plaza, Suite 224 
      Hours: Monday – Friday 7:30 a.m. to 4:30 p.m.
    • After OHF Hours use Emergency Medicine Center/EMC
      Location: BE-144 at the B Level in the Center for the Health Sciences
  • If the injury occurs off campus and requires acute attention, use nearest emergency care facility

2. Complete the form entitled: "UCLA Incident Report and Referral for Medical Treatment"

  • Fill out the top two sections.
  • Send it with the Employee to OHF.
  • The Occupational Health Facility Doctor will fill out the bottom section.
  • The Employee should bring back a completed copy.

3. Give the employee...

  • UCLA Incident Report and Referral for Medical Treatment 
  • “When an Injury Occurs” Pamphlet - This pamphlet contains important phone numbers and maps.
  • Notice of Potential Eligibility Cover Letter
  • "Employee's Claim for Workers' Compensation Benefits" DWC 1 Form
    • Supervisor completes the bottom sections 9 through 17 and signs the form.
    • The employee fills out the top section.
    • Give the Employee a completed, signed copy.
    • Keep a copy of the completed form for your department.
    • Send a copy to Payroll/ Personnel   
    • FAX a copy of the Referral Slip to OIRM  (310) 794-6957 within 24 hours of the injury.

4. Notify...

  • Environment, Health & Safety - call (310) 825-9797 within 8 hours if injury is severe or requires hospitalization
  • Office of Insurance and Risk Management - fax a copy of Employee's Referral Slip to (310) 794-6957 within 24 hours of any injury

5. Investigate the accident and correct the problem immediately. If necessary consult with EH&S.
 

6. If the employee is given time off from work, notify Payroll/Personnel and OIRM

  • Stay in contact with the injured employee.
  • Advise the employee that he/she will need a medical release from the doctor if off work more than three days (not counting day of injury).
  • Remind the employee if the doctor gives them any physical restrictions they must be provided in writing and given to you.
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