Employee Occupational Incident Report
- This report is to be completed by UCSD employees when an occupational (work-related) illness or incident occurs. Submittal of an Occupational Incident Report is not filing a claim for workers' compensation benefits.
- The UCSD Workers' Compensation Office will provide the employee with a California State Workers' Compensation Claim Form (DWC-1), if the work-related injury incident requires medical treatment beyond first aid or lost work days prescribed by a physician. Submittal of a completed DWC-1 claim form to the UCSD Workers' Compensation office activates a workers' compensation claim file.
- If the entire Occupational Incident Report (Employee page and Supervisor page) cannot be completed at the time of initial submittal, complete as many fields as possible. The information with * below is required for initial submittal.
- If the employee is unable to complete an Occupational Incident Report, the supervisor must report the Incident on their behalf.
- If you have any questions, please call your Workers' Compensation representative at: (858) 534-4785 or 822-2979.
Supervisor Occupational Incident Report
Supervisor of injured UCSD employee must complete and submit this report to the Workers' Compensation Office in conjunction with either of the two reporting options utilized by the injured employee
- Option A: Employee reported incident via online Employee Occupational Incident Report, or
- Option B: Employee reported incident via 1-800 Reporting Line: (877) 6UC-RPRT (877-682-7778).