Breadcrumb Home Programs Occupational Health Forms Occupational Health Forms Sub-navigation Sub-navigation Occupational Health About Us Contact Us Location & Hours Occupational Health Leadership Services Provided BBP Exposure Forms Medical Records New-Hire Exams TB Screening Worker's Injury and Illness Care Worker's Compensation, Employer's First Report of Injury or Illness Forms Incident Reporting and Referral for Medical Treatment Forms (Fillable PDF) Incident Reporting is required and ensures that there is a record on file with the employer. If an employee is injured or develops a job-related illness (developed gradually over time) as a result of their employment at UCLA, they must complete and submit these forms (see highlighted fields). If the employee is unable to complete these forms,the supervisor must complete it on their behalf. If an injury occurs, first aid may be the appropriate treatment. Worker's Compensation, Prescriptions How to Fill Prescriptions Form (Fillable PDF) Optum has been chosen by UCLA to manage your worker's compensation pharmacy benefits. If you need prescriptions filled related to your injury, please follow the simple instructions on this form. In English and also en español. Tuberculosis (TB) Screening Form TB Screening Form (Fillable PDF) Pre-Employment Forms Pre-Employment Forms Packet (Fillable PDF) Tdap Declination Forms Tdap Declination Form (Printable Form) Hep B Declination Forms Hep B Declination Form (Printable Form) Rabies Declination Forms Rabies Declination Form (Printable Form)
