Injury and Accident Report

Injury and Accident Incident:

When unfortunate accident occurs on campus and a person is injured, they must be reported. Student injury reports must be filled out by the instructor or staff member. Employee injury report must be filled out by their supervisor. All injury reports will be evaluated by the Facility, Health, and Safety Committee at the monthly meeting. All injury and accident incidents must to reported to OEHS Coordinator Carina Castro or the Safety officer, Dan Gutowshi within 24 hours. They will notify Risk Management at the District. In event of a serious injury that results in overnight hospitalization or death, it is critical that campus notify Cal-OSHA within 8 hours; otherwise, the campus will be fined $5,000 for the incident. 

Student Injury

A student who is injured on campus, must have their instructor or staff member fill out their Student Accident Form. This form must be submitted to OEHS Coordinator or the Safety Officer within 24 hours. If the student needs medical care, they will need go to Student Health Services to be evaluated by the campus health professional. If students need to be taken to off-campus medical care, they will need to be given the appropriate worker comp form. The police academy on campus has several different worker comp forms depending on the recruit hiring status. All other programs will use the standard student worker comp form. 

Employee Injury

An employee (NANCE, Federal Work Student, Classified Staff, Supervisor, and Faculty) who is injured during working hour must notify their supervisor AND OEHS Coordinator or Safety Officer immediately. The Steps for Reporting a Work-Related Injury document details the important steps for the supervisor and employee will need to follow to file a work-related injury report.  Injury and Illness Incident Investigation report and worker comp form (DWC-1 Form) must be filled out by the employee's supervisor within 24 hours of the incident; however, keep in mind of serious injury must reported as soon as possible. Employee has the right to deny medical treatment and must sign Declination of Medical Treatment waiver. Employee may go to Sharp Hospital or Kaiser Hospital locations even if they do not have insurance there to seek treatment. 

Forms and Links:

• Student Accident Form
• Standard Student Worker Comp Form
• Employee Accident Forms
  • Steps for Reporting a Work-Related Injury
  • Employee Injury and Illness Incident Investigation 
  • Declination of Medical Treatment
  • Employee Worker Comp - DWC-1 Form
  • Sharp Hospital Worker Comp Location
  • Kaiser Hospital Worker Comp Location 
• SDCCD Injury and Accident Plan