Workers' Compensation

A safe working environment is our number one priority. However, should an accident or injury occur we want to ensure that our employees receive prompt effective medical treatment.

All injured employers are to be sent to the following occupational clinics:

Kaiser Permanente On-the-Job
400 Craven Rd., 
San Marcos, CA 92078
or 
Palomar Health Corporate Health Services
2125 Citracado Parkway, Suite 130 
Escondido, CA 92078
760-510-7373

If the injury or illness requires emergency care, please go to following Emergency Room:

Kaiser Permanente
400 Craven Road Building 3, 1st Floor
San Marcos, CA 92078
or 
Palomar Medical Center

2185 Citracado Parkway
Escondido, CA 92029

INCIDENT ONLY AND FIRST AID


EMPLOYEE
  • Immediately notify your supervisor of the injury or illness. If your supervisor is unavailable please contact Risk Management at (760) 290-2360 for assistance. 

SUPERVISORS

  • Complete the Supervisors Report of Accident, sign and date. Clearly note at the top of the form INCIDENT ONLY (if it did not result in any treatment or disability) or FIRST AID (any one-time treatment, and any follow up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care). Email a completed copy of the supervisor’s report of accident to Risk Management by the end of the business day.

FORMS TO BE COMPLETED BY SUPERVISOR
Supervisors Report of Accident.pdf

IF MEDICAL TREATMENT IS NEEDED


EMPLOYEE
  • Review, sign, and date the Injured Workers Information Sheet
  • Complete the Certification of Outside Employment, sign and date.
  • Return all forms to your supervisor.

You will be directed to one of the providers in the Medical Provider Network; unless the appropriate Pre-designation form is on file with Human Resources and Risk Management. A medical treatment authorization form will be provided to you by your supervisor.

SUPERVISORS

  • Upon the employee’s report of injury or illness, provide them with a DWC 1 claim form, no later than 1 working day. This form must be hand delivered to the employee, if hand delivery is not possible, please mail the form and notate on the Supervisor Report of Accident that a DWC 1 has been mailed, pursuant to LC 5401(a).
  • Sign the bottom portion of the DWC 1, upon receipt from the employee. Provide the employee with the Injured Workers Information Sheet and the Certification of Outside Employment.
  • Complete the Supervisors Report of Accident, sign, and date.
  • Complete the treatment authorization form to Kaiser On The Job or Palomar Corporate Health Services, give a copy to the employee and retain a copy. If the employee requires transportation, the supervisor shall contact Risk Management and Risk Management will accompany the employee. If the injury or illness is life threatening the supervisor shall contact 911.
  • Contact Risk Management at 760-290-2360 or at nancy.grijalva@smusd.org to advise of said injury at the time it is reported by the employee.
  • Email a copy of the completed Supervisors Report Of Accident and treatment authorization to Risk Management by the end of the business day.

FORMS TO BE COMPLETED BY THE SUPERVISOR
Supervisors Report of Accident
Kaiser Permanente On-the-Job®
Palomar Health Corp Health Services Referral Form

FORMS TO BE GIVEN TO THE EMPLOYEE BY THE SUPERVISOR
DWC1
Certification Of Outside Employment
Injured Workers Information SheetINCDENONLAND FIRST AID

WORKERS COMPENSATION NOTICES AND ADDITIONAL FORMS

Predesignation Of Personal Physician
Independent Medical Review Process
MPN Notice
WC Poster SPANISH
WC Poster ENGLISH

 

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