Employee Incident Protocol

Overview

Here are guidelines for employee reporting of work-related injuries and illness incidents

What is an incident?

An incident is defined as:

  1. A near miss (but no exposure, injury or illness occurs), or
  2. An exposure to a hazardous substance (but no injury or illness occurs), or
  3. An injury or illness

Required actions

Form: Employee Incident Report (EIR)

When any of these occur at work you must immediately take these two steps:

  1. Report the incident(s) to your supervisor.
  2. Fill out an Employee Incident Report (EIR) form or call 877-682-7778 and report the injury directly to Sedgwick. If you complete the EIR form, give a copy to your supervisor.

In the case of an exposure for work-related injury/illness, you must also:

  • For exposure to body fluids or blood call:

Contact the Occupational Health Program here.

  • Follow all established infection control and medical center protocols. Workers' compensation is a separate process.
  • If the incident has resulted in an injury or illness:
    • Obtain medical care promptly (see below).
  • If emergency treatment is required:
    1. Go to the nearest emergency room.
    2. Follow-up with one of our designated occupational medicine providers:
  • For acute (non-emergent) care:
    1. Call one of the following designated occupational medicine providers to arrange an appointment:
      • Occupational Health Services (OHS) clinic hours: 7:30 a.m.–4 p.m. 2330 Post St., 4th Floor, Suite 460, San Francisco 415-885-7580
      • Kaiser On The Job, 601 Van Ness Ave., Suite 2008, Opera Plaza, Mezzanine Level, San Francisco 415-833-9600
      • St. Francis Memorial Health Center at SBC Park; clinic hours: 7:30 a.m.–5 p.m. 24 Willie Mays Plaza, San Francisco 415-972-2249
      • After clinic hours, go to: Long Emergency Department
    2. For follow-up care, go to Occupational Health Services, St. Francis Memorial Health Center at SBC Park, or Kaiser On The Job.
    3. If your treating physician certifies you for disability:
      • Provide your supervisor with medical certification of any and all disability leave dates.
      • Provide your supervisor with medical certification of any and all future changes in disability leave dates.
      • As appropriate, work with your supervisor to develop transitional/modified duty plan

It is very important that you keep your supervisor informed of any leave dates. Your supervisor will need copies of your treating physician's certificate(s) stating the date(s) of your work restrictions and/or disability period. Your supervisor also should be informed of all future changes in those dates. Failure to provide this information may delay your workers' compensation payments, your other insurance coverage, University pay, and/or our ability to engage in the interactive process. First and foremost, it is your responsibility to keep your supervisor apprised of your availability to work.

What is workers' compensation?

Workers' compensation is a medical-legal system designed to assure that an employee who sustains a work-related injury or illness receives medical attention for the injury or illness, as well as partial wage replacement benefits and other support in returning to gainful work.

Benefits provided by workers' compensation

  1. Medical treatment and hospitalization: all reasonable and necessary care; no deductible, no co-payments
  2. Temporary disability (TD): partial replacement of lost wages
  3. Permanent disability (PD): for a ratable degree of residual disability
  4. Supplemental job displacement benefits (SJDB): to assist in return to suitable, gainful employment
  5. Death benefits: payments to surviving dependents if the injury or illness materially leads to death

Who is covered?

All UCSF employees as defined by University policy and the workers' compensation laws of California (labor code) are covered under the workers' compensation program.

Who should file for workers' compensation?

Any employee who feels they have sustained a work-related injury or illness.

What department coordinates the workers' compensation program and receives reports?

Campus:

UCSF Human Resources Disability Management Services, UCSF Box 0964, San Francisco, CA 94143-0964 Phone: 415-476-2621; Fax: 415-353-3232

Health:

UCSF Health Workers’ Compensation Department, UCSF Box 1661, San Francisco, CA 94143-0964  [email protected]; Fax: 415-353-3511

Who authorizes medical treatment and processes workers' compensation benefits?

The University has a third-party administrator, Sedgwick, who makes determination on work-related causation and who processes UCSF workers' compensation claims and issues all benefits. Contact Sedgwick at 800-225-2998.

What other information do I need to know?

  1. Refer all billing and insurance-related questions regarding your medical care to Sedgwick at 800-225-2998.
  2. Refer all treatment authorization questions to Sedgwick at 510-433-5300. Only Sedgwick can authorize medical treatment.
  3. Sedgwick will coordinate all workers' compensation benefits until such time as further benefits are deemed unnecessary.
  4. Who are the UCSF contacts?
    • Campus: UCSF Disability Management Services is available as the liaison should concerns arise regarding the claims process. 
    • Health: UCSF Health Workers’ Compensation Department is available as the liaison should concerns arise regarding the claims process.