Reporting Injuries

If one of your employees is injured at work, you must take the following steps immediately in order to qualify for Workers’ Compensation benefits:

  1. Report the injury to your supervisor or University Personnel – 408-924-2155
    1. If you must seek medical attention first, notify your supervisor or University Personnel as soon as possible.
  2. Seek medical attention

Your supervisor must then take the following steps:

  1. Complete the Employer’s Report of Occupational Injury or Illness [pdf] 
  2. Write the description of the accident using the employee’s own account
  3. Give you (the employee) a copy of the Workers’ Compensation Claim Form (DWC 1) and Notice of Potential Eligibility [pdf]
  4. Sign and submit both forms via DocuSign to University Personnel ( when complete.

Additional Information