Guide to Reporting a Work Related Injury/Illness
When an Employee Suffers a Work Related Injury or Develops a Work Related Illness:
During normal business hours and not out of the area:
Contact the Manager of Workers' Compensation and ADA Accommodations and notify them of the injury/illness. ERC will help assess the nature of the injury/illness and schedule an appointment for the employee at one of the following:
- Sonoma State University Student Health Center (for first aid treatment)
- Kaiser Occupational Health Center, Rohnert Park
- Kaiser Occupational Health Center, Santa Rosa
- Pre-designated physician (Note: Pre-designated Physician Form must be on file with the Workers Compensation Coordinator prior to date of injury or illness.)
Not during normal business hours and/or out of the area:
- Go to a Kaiser Permanente Emergency Room
- Go to the closest Emergency Room if out of area
Within 24 hours after an injury /illness occurs:
- Complete Supervisor's Report of a Work Related Injury/Illness (Word) Form
- Have employee complete the Employee Claim for Workers' Compensation Benefits Form (DWC-1) (pdf)
- Return both completed forms to Employee Relations and Compliance Services, Salazar Hall, within 24 hours of the injury/illness. Please FAX the forms to the confidential FAX line at (707) 664-4049 before submitting it via campus mail.