Workers Compensation and MSJC
It is the Districts goal to maintain a healthy and safe workplace; there are occasions where an employee experiences an occupational injury or illness.
Please take the following steps in reporting any injury or illness while at MSJC.
For Employees: If there is a life threatening injury or illness, call 911.
If not life threatening, please do the following:
· Report ALL workplace injuries/illnesses immediately to your direct supervisor and call Company Nurse at 1-877-518-6702. If your supervisor is not available, report to the next available supervisor.
· Obtain a Treatment Referral Form and directions to the closest clinic (from Supervisor).
The following forms will be given to you, please complete or review and then return to the Risk Management Coordinator.
ü MSJC - Instructions for Injured Employee (Review)
ü MSJC - Injured Employee Statement (Complete)
ü MSJC - DWC-1 (Complete)
ü MSJC - MPN Signature receipt (Complete)
ü MSJC - Covered employee Notification of Rights (Review)
If the injury requires follow up appointments, it is the employee’s responsibility to submit Disability Status Reports to the Supervisor. A post-accident/illness interview will take place with the Risk Management Coordinator within two weeks of the injury.
The District’s return to work program provides for opportunities for injured employees to return to work with medical restrictions as outlined by the treating physician. An important part of recovering from an injury is returning to work. The transitional modified/alternate duties are allowed for 60 business days.
Please review our FAQ regarding workers compensation and if you have any questions, please contact Kara McGee at 951-487-3190 or firstname.lastname@example.org.
For Supervisors: If an employee is experiencing a life threatening injury or illness, call 911.
Upon notification of an employee injury or illness, complete the Treatment Referral Form and print directions for employee.
Proceed to: P:\Departments\Business Services\Worker's Compensation\Forms - proceed to folder #1 and go through all four folders, distributing appropriate forms to employee.