Workplace Injury & Illness
Prompt reporting of workplace injuries and illnesses is essential to ensuring employees receive appropriate care, hazards are addressed, and the District maintains a safe work environment. This page outlines the procedures for reporting work-related injuries and illnesses, along with other important information related to the process. These procedures are part of the District's Injury and Illness Prevention Program (IIPP) and support our commitment to maintaining a safe and healthful workplace.
For more information about workers' compensation and workplace injury/illness reporting, please contact:
Maria Martinez
Administrative Assistant II, Risk Management
(909) 652-6521
maria.martinez@chaffey.edu
Nicole Leonard
Interim Administrator, Risk Management
(909) 652-6523
nicole.leonard@chaffey.edu
What to Do if Injured at Work
IF THIS IS AN EMERGENCY THAT REQUIRES IMMEDIATE MEDICAL ATTENTION, CALL 911!
If you have been injured or become ill during the course of your work, you must report it whether or not medical care is desired.
Step 1. Notify your supervisor and call Company Nurse
As long as the injury/illness is not a medical emergency, notify your immediate supervisor and then call Company Nurse at 1-888-375-0280. Company Nurse will gather information, triage, and provide medical advice. If it recommended that you seek medical care, they will provide information on how to get treatment. Company Nurse will provide Risk Management with a report within minutes.
Step 2. Complete the Workers' Comp forms (if seeking medical treatment)
Once Risk Management receives your Company Nurse report, you will be provided with the forms required to file a workers' compensation claim. These forms are required if you are seeking medical treatment. If you have not received the forms, please contact Maria Martinez at (909) 652-6521. If your injury/illness does not require medical care, you do not have to file a claim.
Step 3. Get medical treatment
If you are accepting medical treatment, go to the pre-approved medical provider that was given to you by Company Nurse. If you are a benefits-eligible employee and have a Physician Pre-Designation form on file BEFORE the injury takes place, you may go to that provider. (See Physician Pre-Designation below for more information.)
Resources
- WC Forms (PDF) - To sign these forms electronically, email maria.martinez@chaffey.edu.
- MPN Pamphlet (PDF)
- Employee Incident Report (PDF)
- Supervisor Incident Report (PDF)
About Sedgwick
Sedgwick is the District's third-party administrator ("TPA") for workers' compensation claims. A TPA is an independent company hired to process claims, manage medical treatment, and distribute benefits on behalf of a self-insured employer. While Sedgwick assists with the operations of a claim, Chaffey, as the employer, remains financially responsible for paying the actual costs associated with claims.
Physician Pre-Designation
An employee may pre-designate their personal physician to treat them for a work-related injury or illness BEFORE an injury occurs, allowing them to receive workers' compensation treatment from their personal physician instead of the employer's designated provider.
Pursuant to California Labor Code § 4600(d), the definition of “personal physician” means someone who is (1) the employee’s regular physician, and (2) who, prior to the injury, has directed medical treatment of the employee, and (3) retains the medical records and medical history of the employee. The physician must agree before the injury to act as the employee's workers' compensation treating physician.
To obtain a Physician Pre-Designation form, email risk.management@chaffey.edu.
