WHAT YOU NEED TO DO IF YOU ARE INJURED AND/OR IN A VEHICLE ACCIDENT WHILE AT WORK

Every occupational injury or illness which results in lost time beyond the date of the incident OR requires medical treatment beyond first aid must be reported to State Fund within five days of knowledge. If an injured employee subsequently dies as a result of a previously reported injury an amended report must be filed within five days of knowledge.
Serious injury, illness, or death must be reported immediately by telephone to the nearest office of the California Division of Occupational Safety and Health.

To Report an Injury:
Step 1
Injured or ill employee must notify their supervisor of the injury and complete Employee Section items 1 – 8 of Form 3301 (Short Form) and give the form to the supervisor.

Step 2
Supervisor of injured or ill employee must complete Employer Section items 9 – 18 of Form 3301 (Short Form) within one working day of receipt of the form from the employee. Within one working day of the supervisor’s receipt of Form 3301 (Short Form) from the employee, DCR Admin must call in the claim and provide copies of Form 3301 (short Form) to the insurer.

Step 3
If no medical attention beyond first aid is required, skip Step 3.
When you go to the doctor’s office, tell them that the injury was work related, and have them contact Zeke or Erika. If Zeke or Erika are not available, get the medical attention that you need, and provide the clinic or hospital with contact info for DCR Admin. Our fax# is the same as our home phone – 530-343-7992.

Step 4
DCR’s Internal Employee Accident and/or Vehicle Accident Report must be completed within 24 hours of knowledge of injury or illness and forwarded to Zeke or Erika.

  • If there is a “near miss”, please write a narrative of the incident, and email it to Zeke.
  • If the injury requires only first aid, you still must notify Zeke or Erika within 24 hours.
  • If the injury requires medical attention beyond first aid, you must notify Zeke or Erika as soon as possible.

Other Requirements and Information:
Mandatory Drug Testing
An employee may be required to submit to a drug and alcohol test if:

  • The injured employee requires immediate medical attention.
  • The injured employee is involved in an accident where a second party is seriously injured.
  • The injured employee is involved in an accident where a second party is fatally injured.

Supervisors:
It is important to note that reporting a claim is an employee’s right and should not be questioned. The most important thing is to make sure the employee receives the medical attention he or she needs.

State regulations mandate that employers provide certain information to their employees. There are claim forms, brochures and posters provided by State Fund available on the Staff page of DCR’s website. In addition, DCR’s accident report forms and WC / Injury / Accident Procedures are also posted to the website.

Supervisors should be prepared to provide the necessary forms and brochures upon an injured employee’s request. Because these forms are periodically updated, please use the most current version posted on the company website.