Workers' compensation provides benefits to employees who have sustained a work-related injury or illness. It is a mandatory coverage provided to all eligible employees in California. It is designed to provide employees with immediate medical attention and other benefits when they sustain a work-related injury or illness.

How to Report an Injury

Employees are responsible for reporting incident details to their immediate supervisor as soon as possible if they have sustained an injury or illness in the course and scope of their employment. Supervisors are responsible for initial distribution of appropriate forms and documentation when noticed for any work-related injury or illness.

Report the injury to your supervisor

Report the injury to your immediate supervisor and submit the completed Workers’ Compensation forms to the workers’ compensation unit within 24 hours by fax at 916-734-2484 or email at hs-workerscompergo@ou.ad3.ucdavis.edu.

Inform your supervisor of your work-related injury/illness via the following methods:

  • In person
  • Telephone
  • Email

Supervisors/Department Managers: Provide the employee with the workers’ compensation claim forms, within 24 hours of knowledge of injury: Division of Workers’ Compensation Claim Form (DWC 1) and Departmental Injury/Illness Worksheet (DIIW), within 24 hours of knowledge of injury. Ensure employee is aware of their reporting obligation.

*If workers’ compensation forms are not provided within 24 hours, report the injury to the Workers' Compensation claim line at 916-734-8789. Please include in your message whether you intend to seek medical treatment for your work-related injury/illness. This is a 24-hour reporting line.

Seek appropriate medical care

  • If non-emergency medical treatment is needed, schedule an appointment with Employee Health Services (EHS) at 916-734-3572.
  • Information regarding care needed outside of normal EHS operating hours can be found on the Employee Health Services (staff only) website.

Environmental Health and Safety is responsible for reporting work-connected fatalities or serious injuries or illnesses to Cal/OSHA within 8 hours of employer knowledge. Serious injuries or illnesses are those which require hospitalization, loss of limb or any degree of permanent disfigurement and must be reported immediately to the Health and Safety Officer at: 916-734-2740, after hours call the EH&S 24-hour pager at 916-816-1994. If there is no answer to the 24-hour pager, please contact the hospital operator at 916-734-2011.

Report the Injury to the Workers’ Compensation Unit

Report all injuries (serious and non-serious) to the Workers’ Compensation Unit within 24 hours.

Phone: 916-734-6180
Fax: 916-734-2484
Email: hs-workerscompergo@ou.ad3.ucdavis.edu

Workers’ Compensation Report

The Workers’ Compensation Report, previously known as the Signal Light Report, provides supervisors and managers with a snapshot of injuries/illnesses filed for UC Davis Health. The report contains easy-to-use filters for a quick review of claims by Division, Month, Year, and Unit. Please follow the instructions below for accessibility to Tableau and the Workers’ Compensation Report. Any inquiries regarding data presented in the report should be sent to the Workers’ Compensation Unit at hs-workerscompergo@ucdavis.edu.

Fill out the ticket as follows, inserting your information into the brackets:

  • Access Type: New Access
  • Access Role: Viewer
  • Access Start Date: [Today’s date]
  • Site: UCD Health
  • Grant Access Similar To: [Your Manager]
  • Requestor Department: [Your Department Name]
  • Server: Production
  • Project:

After adding the request, open your cart and enter the following:

  • Approver: David Frankenberger
  • Brief Cart Title: Add user(s) to OA – HR
  • Detailed Description of Cart Request: Add user(s) to OA – HR
  • List all users to be added along with their email address

Please contact Imran Yousaf or Latha Dumpala with any questions regarding access to the dashboard.