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Safety Series Part 2: Injury Reporting

Man with arm sling filling out paperwork

Management Topic: Safety Series Part 2: Injury Reporting

Dear Colleagues,

This month’s Management Tips on Injury Reporting continues our three-part health and safety series. Outlined below is the reporting procedure in the event of a work-related injury/illness. Work-related injury or illness applies to those who are injured at work or who develop a job-related illness as a result of their employment.

On the day that the employee gives notice to a department supervisor or manager that an injury/illness related to work has happened:

   1. The Department Supervisor needs to report the injury via the appropriate forms and the employee is sent to Occupational Health Department (OH) or Emergency Medicine after hours in the event of severe injuries.*

         •   UCLA Occupational Health Department (OH)

             ○   67-120 Center for Health Sciences at 10833 Le Conte Avenue.

             ○   Call (310) 825-6771, 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 on Gayley Ave, north of Le Conte)

        •   Off-campus employees (those with more than a 30-minute travel time from UCLA campus)

             ○   If the injured employee works at an off-campus location more than 30 minutes away from the UCLA Occupational Health Department, then the employee may be seen by an Occupational Health Clinic Partner. See a list of Occupational Health Clinic Partners.

      Injury reporting should be completed in one of three ways:

         I.  The Department Supervisor and employee complete their sections of the UCLA Incident Report and Referral for Medical Treatment form and send the form with the employee to present to the medical provider.

         II.  Complete this form via the Electronic First Report (EFR) System. In order to use EFR, the following is required:

            •   UCLA Single Sign On – ID & Password

            •   Web browser must be Firefox or Google Chrome (not compatible with Internet Explorer)

            •   Employee record must be in UCPath. This system cannot be used for volunteers.

         III.  Departments noted below* can utilize TriageNow.

   2. The employee returns from OH to the Department Supervisor with the OH Work Status formIf the injury requires treatment beyond First Aid, the department must give the employee a Notice of Potential Eligibility and Workers’ Compensation Claim Form (DWC 1). California law requires this form to be given to the employee within one day of their report of injury/illness.

   3. The department is to immediately email and/or fax Insurance & Risk Management the completed UCLA Incident Report and Referral for Medical Treatment and the signed Workers’ Compensation Claim Form (DWC 1) (if applicable).


          •   FAX (310) 794-6957

   4. In case of severe injury or if an employee is hospitalized overnight: Call EH&S at (310) 825-9797, as OSHA requires notice within eight hours of severe injury/hospitalizationFor more information, please see EH&S’ poster.

   5. If there are temporary work restrictions, the department should always try to keep the employee at work by modifying the job during the period of recuperation. For assistance with modifying the job and completing a Transitional Return to Work (TRTW), contact the Insurance & Risk Management RTW Coordinator at (310) 794-6955.

        •   If the employee is being accommodated with a modified job, a TRTW Agreement is necessary, and the department must require the employee to provide updated work status slips after each medical appointment.

   6. If the injury is delayed or denied by our Third-Party Administrator (TPA), the employee should file for disability benefits with Lincoln Financial. Employees should contact the departmental human resources personnel representative to begin this leave notification process.

   7. If the injury is accepted as work-related and the department is unable to accommodate the temporary work restrictions, the employee will receive temporary disability checks, after a 3-day waiting period, from our workers’ compensation claims management vendor, Sedgwick, CMS. Management should immediately notify their Department Personnel/Payroll representative if their employee is taken off work.

  8. Please contact IRM’s Manager of Employee Disability Management Services when an employee has been released to Return to Work with permanent restrictions. In addition to the workers’ compensation procedures, under Federal and State laws, you are required to engage the employee in the interactive process for job accommodation.

For questions regarding Workers' Compensation, please contact Workers' Compensation Manager Dianna Cumpian at or (310) 794-6954, or Oksana Nersisyan at or (310) 794-6952.

*For Employees in Facilities Management, Events & Transportation, Housing & Hospitality, and DLAM, please use the TriageNow process outlined below:

  • Call TriageNow at 855-213-5436 to report the injury. A registered nurse with TriageNow will immediately assist the injured employee via telephone to guide them to the correct level of care.
  • If clinical intervention is required, the referral for care will be made to the appropriate medical facility and that facility will be notified by TriageNow.
  • Further, for all claims, TriageNow staff will enter the claim into the Employer First Report (EFR) website so that the supervisor is no longer required to complete this task.

For more information, please visit:

Leadership 2029

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