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) 825-2111
UCLA Santa Monica Medical Center Emergency Department): Hours: 24 hours a day, 7 days a week emergency room (ER); Location: 1250 16th Street, Santa Monica; Phone: (424) 259-8400
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: [email protected].