Workers' Compensation
Contents
- First Steps After a Job-Related Injury Occurs
- Transportation of Ill or Injured Employee
- Designated Medical Facilities
- Reporting Requirements
Forms and Guides
- Employee's Guide to Workers' Compensation (PDF)
- Injuries on the Job Poster (PDF)
- Procedures for Workplace Injuries or Illness (PDF)
- Work-Related Injury and Illness Incident Report (OSHA 301) (PDF)
- Work Related Injury and Illness-
Predesignation of Personal Physician, Chiropractor or Acupuncturist (for Work-Related Injury or Illness) (PDF)
First Steps After a Job-Related Injury Occurs
- If the Injury requires emergency assistance, call 9 - 1 - 1.
- In serious illness/injury*, the employee should be transported to the nearest medical facility.
- In minor injury/illness, the injured workers should obtain medical care at the appropriate Designated Medical Facility.
- Leave the accident site undisturbed until Environmental Health & Safety (EHS) has had a chance to inspect it.
- Immediately report the injury/illness to the Employee Leaves and Workers' Compensation Unit, (530) 898-4670.
- Immediately complete the Work-Related Injury and Illness Incident Report (OSHA 301). The employee must be given the completed page 3 of the OSHA 301, “Medical Treatment Information For Work-Related Injury/Illness” to present to the Designated Medical Facilities as authorization for treatment. If page 3 is not provided, the designated medical facility may refuse to treat as a workers’ compensation injury or illness. Submit the completed OSHA 301 to Employee Leaves and Workers' Compensation Unit.
- Immediately complete numbers 11 and 12 on page 3 of the Workers' Compensation Claim Form and Notice of Potential Eligibility - DWC-1 and provide the DWC-1 to the injured employee for completion of numbers 1-6 and 8. Instruct the employee to return the completed form to the Employee Leaves and Workers’ Compensation Unit, Kendall Hall 220 or via fax to (530) 898-5755. If you are unable to provide the DWC-1 to the employee, call (530) 898-4670 immediately for mailing within 24 hours.
* Serious injuries/illnesses include (but are not limited to): serious lacerations; lumbar (back) strains; knee strains or dislocations; possible bone fractures; loss of consciousness or ambulation; life threatening injuries; and exposure to hazardous substances.
Transportation of Ill or Injured Employee
- Supervisors and other employees may not transport ill/injured employees.
- Procedures for Workplace Injuries or Illness (PDF)
- Emergency: call 911 for immediate assistance
- Non-Emergency: Merit Medi-Trans will provide non-emergency transportation to medical facilities. See procedures.
If you experience any difficulties in arranging transportation please contact Workers' Compensation (530)898-4670 or Risk Management (530)898-6588.
Designated Medical Facilities
| Consideration | Location |
|---|---|
| Serious Injury/Illness | Enloe Medical Center Emergency Services 1531 Esplanade, Chico, CA 95926 Phone: (530) 332- 7300 Business Hours: 24 hours per day / 7 days per week |
| Minor Injury/Illness | Chico Immediate Care Medical Center, Inc. (ICMC) 376 Vallombrosa Avenue, Chico, CA 95926 (Next to Wells Fargo Bank) Phone: (530) 891-1676 Fax: (530) 891-1833 Business Hours: Daily 7 a.m. - 9 p.m.* |
| Orland Immediate Care Medical Center, Inc. (ICMC) 1361 Cortina Drive, Ste. A, Orland, CA 95963 Phone: (530) 865-3400 Fax: (530) 865-3386 Business Hours: Monday-Friday 8 a.m. - 6 p.m.* |
|
| Paradise Immediate Care Medical Center, Inc. (ICMC) 5875 Clark Road, Paradise, CA 95969 (Across from Taco Bell) Phone: (530) 877-5433 Fax: (530) 877-5708 Business Hours: Monday-Friday 7 a.m. - 7 p.m. & Saturday-Sunday 8 a.m. - 4 p.m.* |
|
| *Outside ICMC business hours Any injury/illness occurring after Immediate Care Medical Center, Inc. business hours should be directed to: Enloe Medical Center Emergency Services 1531 Esplanade, Chico, CA 95926 Phone: (530) 332-7300 Business Hours: 24 hours per day / 7 days per week |
|
| Employee has Pre-Designated a Personal Physician, Chiropractor or Acupuncturist |
If an employee has pre-designated his or her own personal medical doctor (M.D.), doctor of osteopathic medicine (D.O.), medical group, chiropractor or acupuncturist to act as their primary treating physician for a work-related injury or illness, he or she may obtain medical treatment from his or her own provider. An employee must have a current Work Related Injury and Illness - Predesignation of Personal Physician, Chiropractor or Acupuncturist (for Work-Related Injury or Illness) form naming that provider on file with the The Employee Leaves and Workers' Compensation Unit prior to a work-related injury or illness. |
Reporting Requirements:
- Report the illness/injury IMMEDIATELY to Employee Leaves & Workers' Compensation Unit, (530) 898-4670.
- The employee's direct supervisor (or supervisor's designee) must immediately download and complete the Work-Related Injury and Illness Incident Report (OSHA 301). Please follow Supervisor instructions carefully.
- Leave the scene undisturbed and report the illness/injury immediately to Environmental Health and Safety, (530) 898-5126.