Step #1: Get Medical Attention

Employees should obtain medical treatment at OHF for non-emergencies that occur during normal business hours, or the RRMC Emergency Department for emergencies and/or off-hours treatment. See below for additional information:

SERIOUS INJURIES: Page The Office of Environmental Health & Safety (EH&S) IMMEDIATELY (Pager: 90248)

Provide the necessary information when reporting a serious injury:

  • Employee name, title and department
  • Supervisor name and phone
  • Your name, title, department and contact information
  • Date, time and location of incident
  • Description of what happened
  • Whether or not employee got medical treatment and, if so, where

Serious injury includes:

  • Amputation
  • Concussion
  • Injury resulting in serious degree of permanent disfigurement such as crushing injury or severe burn
  • In-patient hospitalization in excess of 24 hours for other than medical observation

*If serious injuries are not reported within 8 hours, departments can be fined $5,000.00 by Cal/OSHA.

Download a copy of the Serious Injury Poster

Step #2: Complete Necessary Forms

  1. UCLA Health Incident Report & Referral for Medical Treatment Form 
  • Required as a record that an injury or illness was reported
  • Take the completed form to OHF/ER
  • Your medical provider will describe your received treatment and any work restrictions or future appointments
  • Be sure to return the form to your supervisor after treatment
  1. Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility
  • Must be provided by a supervisor within 24 hours of the report of injury or illness

Step #3: Report the Injury to HR/Workers’ Compensation

Contact HR/Workers’ Compensation within 24 hours for ALL injuries

  • Report all injuries (serious and non-serious) to HR/Workers’ Compensation within 24 hours
  • Phone: (310) 794-0500; Fax: (310) 794-6957Email: [email protected]

Step #4: Complete an Event Report

Access SOFI (Safety Opportunities for Improvement)

UCLA Health HR Workers Compensation
UCLA Occupational Health Services