Job-Related Injury or Illness Supervisor Responsiblities

  1. Ensure that employee gets appropriate medical attention.
      1. Student Health Center, when classes are in session.
      2. Mad River Occupational Health.
      3. Any Emergency Room
      4. If requires immediate emergency assistance, call 9-1-1 from a campus phone (rings at University Police and officers are dispatched immediately).
  2. Ensure that appropriate paperwork is complete and submit to Human Resources within 24 hours of injury:
      1. Supervisor's Injury Prevention Report (STD. 620)
      2. Employee Claim Form (DWC-1)
      3. Contact Cindy Darnall Stevens in Human Resources: (707)826-5171
  3. Supervisors should make preliminary investigation of accident.
    1. Complete Supervisor's Injury Prevention Report (STD. 620).
      1.  Fill in all areas of form as completely as possible.
      2. Attach clarifying statements as needed to express any work-related concerns and impressions. Sedgwick will investigate further if necessary.
      3. Deliver Supervisor’s Report to Human Resources within 24 hours of notification of injury or illness.  Do not wait for employee to return employee claim form.
  4. Stay actively involved in the status of the employee.
    1. Notify Human Resources if employee misses work beyond date of injury.
  5. The goal of the University is for the employee to return to work as soon as medically possible. 
    1. If necessary, modify job duties to include lighter and/or part time work based on:
      1. Employee's education, training and work experience.
      2. How soon employee is expected to resume full duty status.
      3. Any work restriction imposed by treating physician.
      4. Under no circumstance should injured employee be placed in job where medical condition will be aggravated or cause harm to fellow employees or state property
  6. Notify Human Resources as soon as employee returns to work.

For more information regarding Workers' Compensation, please refer to the Workers' Compensation Website.