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

For Students:

Student nurses 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 student nurses must complete and email the three documents below to [email protected] if they are injured in one of the following scenarios:

• off-campus (includes Azusa main campus or any regional campus); or
• non-APU laboratory incident

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

Documents for Students' Reference

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

For Supervisors of Students:

The Clinical 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 student nurse. HR does need the Student's DOB and SSN, as part of the information requested on the claim form, as they do not have access to the student's personal information.

Questions and Concerns

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