If You Are Injured...
-IF EMERGENCY CARE IS NEEDED CALL 911-
The injured employee with their site supervisor or representative will call Company Nurse at (888) 375-0280 Immediately!
- A triage nurse will determine the employee medical action plan.
- Company Nurse will generate a Workers' Compensation Claim Form (DWC-1).
The DWC-1 form, Supervisor's Incident Investigation Report and Employee Incident Investigation Report will be emailed to the Site Representative to oversee and ensure its completion.
- Whether or not the employee is directed to seek medical care, the DWC-1 form, Supervisor's Incident Investigation Report and Employee Incident Investigation Report must be completed.
- These forms must be returned to Meaghan Pratt in Personnel, and Robert Chacon in Risk Management, as soon as possible (within 24 hours).
If the employee is directed to seek medical attention, Company Nurse will direct the employee to an appropriate facility that is part of our Medical Provider Network (MPN).
If the employee requests to be seen by his/her own private doctor and that doctor is not a member of the MPN, then there must be a predesignated physician form on file in Human Resources for that employee. You can contact Meaghan Pratt in Personnel to see if one is on file.
If the doctor gives the employee any medical restrictions, it must be determined by Human Resources whether or not the employee can return to his/her regular job with modified duties.
Cal OSHA Reporting Responsibilities
EMPLOYERS REPORTING RESPONSIBILITIES TO CAL/OSHA PERTAINING TO
ON-THE-JOB INJURIES AND ILLNESS
Incidents requiring reporting to the Division within 8 hours:
- Fatal injury to an employee
- Serious injury or illness to employee. A serious injury or illness is defined as:
- “any injury or illness occurring in a place of employment or in connection with any employment which requires inpatient hospitalization for a period in excess of 24-hours for other than medical observation” and:
- Loss of a member of the body (e.g., amputation)
- Serious degree of permanent disfigurement (e.g., crushing or severe burn type injuries)
- Multiple worker injuries requiring hospitalization
Every employer shall report immediately by telephone or fax to the nearest District Office of the Division of Occupational Safety and Health (Cal/OSHA) any serious injury or illness, or death, of an employee occurring in a place of employment or in connection with any employment.
“Immediately” means as soon as practically possible but not longer than 8 hours after the employer knows or with diligent inquiry would have known of the death or serious injury or illness. If the employer can demonstrate that exigent circumstances exist, the time frame for the report may be made no longer than 24 hours after the incident.
Information required to be reported to the Division*:
- Time and date of accident.
- Employer’s name, address and telephone number.
- Name and job title, or badge number of person reporting the accident.
- Address of site of accident or event.
- Name of person to contact at site of accident.
- Name and address of injured employee(s).
- Nature of injury.
- Location where injured employee(s) was (were) moved to.
- List and identity of other law enforcement agencies present at the site of accident.
- Description of accident and whether the accident scene or instrumentality has been altered.
*Document Time, Date and Name of person who received the report.
Cal OSHA San Bernardino Office
464 W. 4th Street, Suite 332
San Bernardino, CA 92401
Phone: (909) 383-4321
Fax: (909) 383-6789