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Workers' Compensation

Workers' Compensation and MSJC

It is the District's 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 (from a District phone dial 8-911).

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 and/or Nicole Piña, Human Resources Analyst, via email at npina@msjc.edu or via phone at 951-487-3135. 
  • Obtain a Treatment Referral Form and directions to the closest clinic from Human Resources.

The following forms will be given to you. Please complete or review and then return to Human Resources.

MSJC Instructions for Injured Employee (Review)
MSJC Injured Employee Statement pdf fill (Complete)
MSJC DWC1 (Complete)
MSJC MPN Signature Receipt (Complete)

MSJC Covered EE Notification of Rights Materials (Review)

If the injury requires follow up appointments, it is the employee’s responsibility to submit Disability Status Reports to the supervisor.

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 up to 60 business days.

Please review our FAQs regarding workers compensation and if you have any questions, please contact Nicole Piña via email at npina@msjc.edu or via phone at 951-487-3135.

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For Supervisors: If an employee is experiencing a life threatening injury or illness, call 911 (from a District phone dial 8-911).

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.