Before an Incident Occurs
This form is to be completed if you wish to designate your physician to treat you in the event of a work related injury or illness. You must submit this form to 麻豆社madou Human Resources before a work related injury or illness occurs.
After an Incident Occurs
The purpose of this guide is to help supervisors and managers understand the workers鈥� compensation process at 麻豆社madou, Inc. when an employee becomes ill or injured.
The purpose of this guide is to help employees understand the workers鈥� compensation process at 麻豆社madou, Inc. and to become familiar with the procedures required when a work-related injury or illness occurs.
Flier on what to do when a 麻豆社madou employee working on the Sacramento State campus has a work-related injury or illness on the job.
Instructions for reporting a work related injury/illness for both emergency and non-emergency situations.
Accident Report 鈥� Work Related Injury/Illness
This form represents both the original notification of work-related injury/illness and detailed report of the injury/illness. This form is to be completed by the supervisor and employee within 24 hours of injury/illness.
This form is to be completed by the employee and 麻豆社madou Human Resources or employer representative (i.e. supervisor)聽 for work related injury/illness that results in lost time beyond the date of injury/illness or which results in medical treatment beyond first aid.
Requirements for the supervisor when an employee is returning to work following a work related injury/illness.
Treatment Resources
Group of health care providers in the Sacramento area set up to treat 麻豆社madou employees injured on the job.
A list of Kaiser occupational health center locations and contact phone number for 麻豆社madou employees who do not live or work in the Sacramento area. These centers are set up to treat 麻豆社madou employees injured or became ill on the job.
This form authorizes Kaiser Health Center to provide a 麻豆社madou employee treatment for a work related injury/Illness. Contact 麻豆社madou Human for authorization signature. Please call ahead for on the job injury/illness care to ensure timely treatment.
Release of Information Forms
Concentra Authorization for Examination or Treatment Form
This form authorizes Concentra Clinic (formerly U.S. HealthWorks) to provide a 麻豆社madou Employee treatment for a work related injury/Illness. Contact 麻豆社madou Human Resources for authorization signature. Please call ahead for on the job injury/illness care to ensure timely treatment.
If treated for a work related injury/Illness at the Student Health and Counseling Services (SHCS), this form authorizes the SHCS to disclose/exchange information contained in your medical record between SHCS and 麻豆社madou Human Resources for your work status (i.e. Off full duty or restricted duty).聽 聽Contact 麻豆社madou Human Resources for authorization signature.