Employee Incident Protocol

Home / Campus / Workers Compensation ( Published on 2014-09-03 )

Form: Employee Incident Report (EIR)

An "Incident" is:

  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

When any of these occur at work there are two (2) steps you must take immediately:

  1. Report the incidence(s) to your supervisor.
  2. Fill out an Employee Incident Report (EIR) form or call 1-877-682-7778 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:
  • 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. Then follow-up with one of our designated occupational medicine providers:
      • Occupational Health Services 415/885-7580
      • St. Francis Memorial Health Center at SBC Park 415/972-2249
      • Kaiser on the Job 415/833-9600
  • 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. to 4 p.m. 2330 Post St., 4th Floor, Suite 460, San Francisco, CA. 415/885-7580
      • St. Francis Memorial Health Center at SBC Park; clinic hours: 7:30 a.m. to 5 p.m. 24 Willie Mays Plaza, San Francisco, CA. 415/972-2249
      • Kaiser On The Job, 601 Van Ness Ave., Suite 2008, Opera Plaza, Mezzanine Level, San Francisco, CA. 415/833-9600
    2. After clinic hours, go to: Long Emergency Department
    3. For follow-up care, go back to: Occupational Health Services, St. Francis Memorial Health Center at SBC Park, or Kaiser On The Job.
    4. 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 unit supervisor informed of your leave dates. Your supervisor will need copies of your treating physician's certificate(s) stating the date(s) of your medical disability. Your supervisor should also be informed of all future changes in those dates. Failure to provide this information may delay your workers' compensation payments and/or affect your other insurance coverage.

What is workers' compensation?
Workers' compensation is 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.

What benefits are 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).

Who should file for workers' compensation?
Any employee who feels they have sustained a work-related injury or illness.

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

UCSF Human Resources
Campus Disability Management Services
UCSF Box 0964
San Francisco, CA 94143-0964
Phone: 415/476-2621; Fax: 415/476-2328

Who authorizes all medical treatment and processes all workers' compensation benefits?
The university has an outside Third Party Administrator who processes UCSF workers' compensation claims and issues all benefits. This company is Sedgwick, 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 CMS can authorize medical treatment.
  3. Sedgwick will coordinate all workers' compensation benefits until such time as further benefits are deemed unnecessary.
  4. The UCSF Disability Management Services is available as the liaison should concerns arise regarding the claims process.