Workers' compensation is a state-mandated, employer-paid benefit for employees that sustain occupational injuries or illnesses while working for or on behalf of the University.  San José State University (SJSU) employees, including staff, faculty, special consultants, student assistants, work-study students and appointed volunteers are covered.

REPORTING PROCEDURE WHEN INJURED

1. Report the injury immediately to your Appropriate Administrator or his/her designee.

Within 24 hours, the Appropriate Administrator or his/her designee completes the employer's report form and provides a copy of the workers' compensation claim form to the employee. Please fax the forms to Human Resources at 408-924-2144 and send originals via campus mail to Human Resources (Mail Stop 0046).

2. In case of emergency, dial 911 for paramedic assistance or (408) 924-2222 for University Police Department.

3. Seek immediate medical treatment.

• For minor injuries requiring first aid only, employees should go to Student Health Center. Call (408) 924-6120 for general information.

For medical treatment beyond first aid, employees should go to approved Occupational Medicine Facilities.

4. Provide all Physician Medical Work Status Reports to your appropriate administrator or his/her designee and the workers’ compensation specialist.

5. For more information or questions contact the Workers’ Compensation Specialist in Human Resources at (408) 924-2155, Sedgwick CMS the third party administrator at 510-302-3041 or the State of California Division of Workers’ Compensation Information & Assistance Unit at 1-800-736-7401

 Injury Report Forms:

• Employer's Report of Occupational Injury or Illness (PDF): Write a description of the accident using the employee's own account of the incident and submit to University Risk & Compliance.

• Workers' Compensation Claim Form (DWC 1) and Notice of Potential Eligibility (PDF): Provide the injured employee with this form. When the employee completes and returns this form to you, forward it on to University Risk & Compliance.

For more information, see:

• Occupational Injury or Illness Reporting Policy (PDF) 
• Occupational Injury Return-to-Work Program (PDF) 
• Predesignation of Personal Physician Form (PDF)
• Employee Injury Care Student Health Center Procedures (PDF)

To contact us, see Workers' Compensation.