Faculty & Staff

Chapter 2:
When an Injury or Illness Occurs at Work

Supervisors' Checklist
Reporting an injury/incident
Medical Treatment/Facilities
Employee Personnel Files
Questions and Answers

You want to be prepared when an injury occurs at work. The following is a checklist you may use as a supervisor to ensure the proper steps are taken. Additional information is provided following the checklist.

Supervisor's Checklist

Step 1
Emergency Care (serious injury, threatening to life or limb)

  • Dial 911 or or 2-3333 for campus police
    (EH&S and Disability Management Services must be immediately notified if injury results in fatality, inpatient hospitalization, loss of any body part, or possible permanent disfigurement)

Acute Care (non-emergency)

  • Direct employee to the Tang Center (2222 Bancroft Way)
    • Urgent Care Clinic (2-3188) - including first-aid care
    • Occupational Health Clinic (2-6891)
      (If medical care is needed after clinic hours, please direct the employee to Alta Bates Medical Center's Emergency Room (2450 Ashby Avenue, Berkeley) or the emergency facility of his or her personal health plan)

Step 2
Investigate the accident and address the problem.

  • Correct any immediate hazards to prevent further injuries.
  • Do NOT discard equipment or furnishings that caused injury.
    • Remove the equipment from service.
    • Tag the equipment for identification.
    • Contact EH&S (2-3073) for inspection.
  • Provide accident summary and corrective actions taken to department safety committee.

Step 3
Within ONE working day of your knowledge of the injury, do the following:

  • Complete the Employer's Report of Incident
  • Do NOT give this form to the employee to complete.
  • Fax the completed form to Disability Management Services (fax # 2-6505).
  • Keep a copy for departmental records.

Do NOT give your employee the Workers' Compensation Claim Form (DWC-1).

Step 4
To ensure prompt and accurate payment of benefits, if your employee loses time from work (beyond the date of injury), please do the following:

  • Inform your department's payroll unit.
  • Inform Disability Management Services: 3-9403 (last names beginning with A-L),
    3-6921 (last names beginning with M-Z).

Step 5
Stay in contact with your injured employee to show concern for his/her well-being and desire for him/her to return to work. Discuss a mutually convenient time to call.

Step 6

Discuss possible accommodations, if necessary, when your employee is medically able to return to work.

  • Document accommodation discussions.
  • When your employee returns to work, immediately inform Disability Management Services (3-9403 A-L, 3-6921 M-Z).
  • If you need assistance with reasonable accommodations, contact Disability Management Services (3-7921).

Medical Treatment/Facilities (return to top)
If the situation is immediately threatening to life or limb, get emergency care.

On Campus: dial 911 for paramedic assistance or 2-3333 for campus police.
Off Campus: use the nearest available medical facility for care.

Make sure the employee tells the treating physician or other appropriate medical facility staff that the injury happened while working. Have the employee provide the names of his/her department, direct supervisor and the University's Workers' Compensation administrator, Sedgwick CMS, P.O. Box 14533, Lexington, KY 40512-4533, (510) 302-3180.

Tang Center
Urgent Care:
For serious injuries not threatening to life or limb, urgent care is available on a drop-in basis at the Urgent Care Clinic at the University Health Services, Tang Center at 2222 Bancroft Way, Berkeley, CA 94720 ((510) 642-3188). The entrance for Urgent Care is on Durant Ave. Urgent Care is open Monday through Saturday during fall/spring and Monday through Friday during summer and winter break. If UHS is closed, employees may use Alta Bates Medical Center’s Emergency Room located at 2450 Ashby Avenue, Berkeley, CA 94705 or the emergency room of their personal health plans. Follow-up visits for medical care can be scheduled with the Occupational Health Clinic (OHC) by calling (510) 642-6891.

Non Urgent Care: An injured employee may be treated at the Occupational Health Clinic (OHC) by calling (510) 642-6891 for an appointment, or may be treated by his/her personal physician if predesignated by the employee before the injury. "Personal physician" is defined as a “medical or osteopathic physician, chiropractor or licensed acupuncturist who has previously directed the medical treatment of the employee, and retains his/her medical records including the medical history.”

Designation of Physician: Supervisors must have the Designation of Personal Physician for Workers' Compensation form available to employees. If the employee has chosen to fill it out, the form should be kept in the employee’s personnel file. See the Forms section of this Handbook for a copy of the Designation of Personal Physician for Workers' Compensation form.

Employee Personnel Files (return to top)
To protect the employee’s privacy, any documents that relate to an injury or disability including the Employer’s Report of Occupational Injury and Illness (FORM 5020) and the Employee’s Claim for Workers’ Compensation Benefits (DWC Form 1) must be kept in a separate file from the rest of an employee’s personnel file. The documents may be kept inside or adjacent to the personnel file, but should be kept separate. Check with your Employee Relations Specialist or a Vocational Rehabilitation Counselor if you have any questions about medical records. Visit http://hrweb.berkeley.edu/guide/contents.htm for more details.

Questions and Answers (return to top)

Q. What if I don’t have all the information for completing the Employer's Report of Incident?
A. The Employer’s Report of Incident form must be faxed to the Disability Management Services Office whether or not you have all the information requested on the form. Delaying the form may seriously jeopardize the employee’s disability payments or medical care, as well as the claims investigation process. With the available information received, complete the form the best you can.

Q. What is the supervisors’ responsibility for administering first-aid to an injured employee?
A. You can administer first aid if you have a first aid kit or send the employee to the Urgent Care Clinic at the University Health Services, at the Tang Center, 2222 Bancroft Way, for medical attention.

Q. Can I or my employee come to the University Health Services at the Tang Center even if the employee’s injury is not work-related?
A. No. For personal health care problems, the employee should seek his/her own health care provider. The University Health Services is only available to employees with work-related injuries unless the employee chose the University as his/her health care provider through HealthNet when choosing a health plan.

Q. If my employee calls in to report “back problems,” are they considered work-related injuries?
A. Ask the employee what happened. If the employee states that the back problems are work-related, complete the Employer’s Report of Incident form and fax it to Disability Management Services ((510) 642-6505). Medical examinations and claims investigation will determine the nature and extent of the employee’s injury.

Q. Who determines what benefits an employee is eligible for and whether or not the injury is work-related?
A. The type and amount of benefits are established by law. Sedgwick CMS, the third-party administrator, determines whether the injury is work-related or not, after talking with the employee and supervisor, reviewing the medical reports, and sometimes requiring additional medical evaluations.

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