Incident Reporting

When an Employee Suffers a Work-Related Injury or Develops a Work-Related Illness:

Contact Workers' Compensation at (707) 664-2664 or [email protected] and notify them of the injury/illness. Injured employees who need medical attention, but not immediately, are required to contact Workers' Compensation at (707) 664-2664. The Workers' Compensation Office will coordinate an appointment with Kaiser Occupational Health Services. Injured employees are not to contact Kaiser Occupational Health Services directly nor should they seek treatment from their personal physician (unless a Designation of Personal Physician form is filed with the Workers' Compensation Office prior to the injury occurring). 

In the event of an emergency, call 911. Injured employees in need of immediate medical attention are to seek treatment at the Kaiser Emergency Room in Santa Rosa or the closest Emergency Room if out of the area.

As soon as possible, but no later than 24 hours from the time of the injury/illness, managers are required to:

• Complete the Supervisor's Report of a Work Related Injury/Illness;
• Provide the Employee Claim for Workers' Compensation Benefits Form (DWC-1) to the injured employee to complete and sign*; and 
• Return both forms to [email protected]

*NOTE: If the employee is reporting as an Incident Only and refuses medical care, they should NOT complete the DWC-1 form.

The following must be reported immediately: in-patient hospitalization, amputation, loss of eye, death, or any serious degree of permanent disfigurement

In an effort to prevent future incidents, the department of Environmental Health and Safety may reach out to the injured employee and their manager to investigate the incident. This investigation would be to determine root cause and any contributing factors, not to find fault.