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  • How to Report Worker's Compensation Claims
    Step 1:
    Each Employee is responsible to immediately report to their Supervisor that they have been injured themselves while working#
    Step 2:
    If an EMERGENCY, DIAL 911 and get Employee treated# Call 1-888-375-9779 Company Nurse on Call 24/7 Hotline AFTER treatment,
    Step 3:
    Employee/Supervisor calls 1-888-375-9779 and give code "CSIG" Company Nurse on Call 24/7 Hotline with Employee present, BEFORE Employee leaves the premises# Then, Company Nurse will determine:
    1. First Aid Advice Only - The Nurse obtains information about the incident and will provide advice, which the Employee is to follow# The Employee may return full time to their regular position# If medical situation worsens or does not improve, the Employee is to call back Company Nurse for appropriate medical referral#
    2. Medical Referral - If the Nurse determines medical treatment is needed, they refer Employee to your district's designated Medical Facility; Employee then goes to designated Medical Facility for treatment #unless they have pre-designated their personal physician prior to the injury##

    Step 4:
    Company Nurse transmits Supervisor's Report of injury to District Claims Coordinator#

    Step 5:
    Employee returns copy of Work Status Slip to District Claims Coordinator:

    1. Release to full duty
    2. Released with work restrictions or limitations
    3. No release to work
    4. If work restrictions apply, the District Claims Coordinator will work to either modify the Employee's usual job or provide a Temporary Work Assignment #bridge##

    Step 6:
    CCCSIG will mail Employee a DWC-1 Workers' Compensation Claim Form to complete immediately to begin the claim process# State law requires that this form be provided to the Employee or a dependent within one #1# working day of receiving notice or knowledge or any  injury being work-related#

    Step 7:
    For Safety Prevention Focus - For All Incidents: Supervisor to complete CCCSIG form "Accident Investigation Form" which will be sent to the supervisor by email from the District HR Office# You may then fax the form to #510# 412 - 0457 or email or
    Human Resources Department

    1108 Bissell Avenue
    Richmond, CA 94806
    Office: (510)231-1185
    link to Nondiscrimination and Uniform Complaint policies and procedures