How to Report an Injury

How to Report an Injury

February 11, 2014

Step #1: Get Medical Attention

Employees should obtain medical treatment at OHF for non-emergencies that occur during normal business hours, or at Ronald Reagan UCLA Medical Center for emergencies and/or off-hours treatment. See below for additional information:

  • Occupational Health Facility (OHF): Hours: M – F between 7:30 a.m. – 4:30 p.m.; Location: 10833 Le Conte Avenue, CHS 67-120 (This is on the 6th floor, 7th corridor, Room 120. Enter through the School of Dentistry on Tiverton Drive and proceed on the “O” elevator to the 6th floor.); Phone: (310) 825-6771
  • Ronald Reagan UCLA Medical Center (RRUCLAMC): Hours: 24 hours a day, 7 days a week emergency room (ER); Location: 757 Westwood Plaza (ER entrance on Gayley Avenue); Phone: (310) 267-8400
  • Off-Campus Injuries: If injury occurs off the UCLA campus, use the nearest designated facility for your organization. Your HR department can direct you to the appropriate facility
  • Students (not student workers): Go to the Arthur Ashe Student Center or to the RRUCLAMC for emergencies or off-hours treatment

Step #2: Complete Necessary Forms

  1. UCLA Incident Report & Referral for Medical Treatment Form
  • Required as a record that an injury or illness was reported
  • Take the form with you when you seek medical attention
  • Your medical provider will describe your received treatment and any work restrictions or future appointments
  • Be sure to return the form to your supervisor after treatment
  • Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility
    • Use if treatment beyond first aid is required
    • Must be provided by a supervisor within one day of the report of injury or illness
    • Also supply the pamphlet When an Injury Occurs which answers questions and provides telephone numbers

    Step #3: Report the Injury to EH&S and IRM

    1. Contact EH&S Hotline within 8 hours for SERIOUS injuries
      • Report serious injuries within 8 hours to the EH&S Hotline: (310) 825-9797 (The EH&S Hotline is monitored 24 hours a day, 7 days a week)
      • Provide the following information when reporting a serious injury:
        • Employee name, title and department
        • Supervisor name and phone
        • Your name, title, department and contact information
        • Date, time and location of incident
        • Description of what happened
        • Whether or not the employee got medical treatment and, if so, where
      • If serious injuries are not reported within 8 hours, departments can be fined $5,000.00 by Cal/OSHA
      • Serious injuries are listed on the Serious Injury Poster
    2. Contact Insurance and Risk Management (IRM) within 24 hours for ALL injuries
    • Report all injuries (serious and non-serious) to IRM within 24 hours
    • Phone: (877) 682-7778; Fax: (310) 794-6957; Email:

    Biohazard Exposures

    Injury Prevention Program Division
    Email: | Phone: (310) 794-5329 | Fax: (310) 825-7076


    501 Westwood Plaza, 4th Floor
    Box 951605
    Los Angeles, California 90095-1605