Report an Injury

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:

  • Occupational Health Facility (OHF)Hours: M – F between 7:30 am – 4:30 pm; Location: 10833 Le Conte Avenue, CHS 17-240 (1st floor Main Lobby of CHS, near Cafe Med); Phone: 310-825-6771
  • Ronald Reagan UCLA Medical Center (RRUCLAMC): Hours: 24 hours a day, 7 days a week emergency room (ER); Location: 757 Westwood Plaza (ER entrance on Gayley Avenue); Phone: (310) 267-8400
  • Off-Campus Injuries: If injury occurs off the UCLA campus, use the nearest designated facility for your organization. Your HR department can direct you to the appropriate facility

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)

    Links
    UCLA Health HR Workers Compensation
    UCLA Occupational Health Services