This article is for employees who need to process an application for when they are injured or have had an accident. For serious emergencies, please call 911. 

Faculty and staff can seek immediate or follow-up treatment at a nearby Concentra Clinic or Kaiser's Occupational Health Center locations (non–Kaiser Permanente members can also be treated). An authorization form is required.

Injured employees must complete and email the three documents below to [email protected]:

1. Acknowledgement of Receipt of WC documents
2. DWC1 Form
3. Accident-Illness Report APU Student

Documents for Employees' Reference

• DWC7 Form
• The Hartford CA MPN Employee Notification (English and Spanish)
• DWC Employee Fact Sheet

For Supervisors of Employees:

The Direct Supervisor should complete the Supervisors Report of Accident Form to help expedite the details of the incident, as HR awaits for the incident report from the injured employee. Please see the Injured Employee Flow Chart (rev. 5.2022) for administrative and internal reference only.

Questions and Concerns

If you have questions, comments, or suggestions, please email [email protected]