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 67-120 (This is on the 6th floor, 7th corridor, Room 120. Enter through the School of Dentistry on Tiverton Drive and proceed to the “O” elevator to the 6th floor.); 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
- 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
- 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) 794-6957; Email: hrworkerscomp@mednet.ucla.edu.
Step #4: Complete an Event Report
Access SOFI (Safety Opportunities for Improvement)
Links
UCLA Health HR Workers Compensation
UCLA Occupational Health Services
