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WHAT TO DO IN CASE
OF AN EMPLOYEE
INJURY OR ILLNESS
If an employee (including faculty members, staff members, managers, student assistants, and authorized volunteers) becomes ill or
suffers an injury while on campus, use the following guidelines to ensure the safety of the employee and to fulfill your obligations to
report the incident.
SECURING MEDICAL TREATMENT
1. If the injury or illness requires immediate medical attention, call 911. (Examples of injuries, illnesses, or behaviors that
might require immediate medical attention include, but are not limited to, head injury, back or neck injury, seizures, loss of
consciousness, chest pain, amputation, cut requiring stitches, unexplained vomiting, or other unexplained symptoms).
If the supervisor believes that an employee requires immediate medical attention, or there is any question as to the severity of
the injury, call University Police Department immediately at x5555 or by dialing 911.
2. If the injury or illness is clearly minor in nature and the employee refuses emergency transportation, the employee
should be transported to one of the following medical facilities by Merit Medi-Trans (see #3 below).
Regardless of the severity, the supervisor shall ask the employee if he/she desires immediate medical treatment at the time of
the injury, and, if desired, call 911.
Immediate Care Medical Center (ICMC)
376 Vallombrosa Avenue, Chico, CA 95928 (next to Wells Fargo Bank)
Phone: (530) 891-1676
Business Hours: Daily 7 a.m.-9 p.m.
For treatment outside ICMC business hours:
Enloe Medical Emergency Services
1531 Esplanade, Chico, CA 95926
Phone: (530) 332-6300
Business Hours: 24 hours per day/7 days per week
EMPLOYEE PRIVACY: Departments, supervisor and co-workers are free to check-in on the well-being of an ill or injured
employee, which includes visiting the ill or injured worker at the location where medical treatment is being provided. To help
protect the ill or injured employee's privacy, supervisors and other employees should not be present during the evaluation or when
other medical information (past or present) is shared.
3. Merit Medi-Trans will provide non-emergency transportation to the medical facility.
Employees and supervisors may not transport an ill or injured worker. An illness or injury may often present risks that are not
immediately apparent, and the University has contracted with professional transportation providers to minimize the risk to the
ill or injured employee and their co-workers.
The University has contracted with Merit Medi-Trans to provide non-emergency medical transportation to Immediate Care
Medical Center (during normal business hours) or to Enloe Medical Center Emergency Services. The Merit Medi-Trans
service is available 24 hours a day, seven days a week.
a.) To arrange transportation services through Merit Medi-Trans, the ill or injured employee's supervisor or co-worker
should call Merit at (530) 893-8690 to schedule the pick-up. If Merit is able to provide transportation within a
reasonable amount of time as determined by the ill or injured employee, the appointment should be scheduled, and an
Non-Emergency Transport of Injured/Ill Employee (Request Form) needs to be completed and faxed to Merit at (530)
893-8686. The employee will not be charged for transportation provided by Merit Medi-Trans.
b.) If Merit is not able to provide timely transportation for the ill or injured employee, the employee's supervisor should
request emergency transportation by calling 911.
c.) If an ill or injured employee refuses transportation of all types, the supervisor should call University Police
Department at x5555 who will make an assessment of the ill or injured worker. University Police Department will not
transport an ill or injured employee.
ELWC-Procedures-for-Workplace-Injuries-Illness.pdf | Rev. 10/18/2016
Page 1 of 3
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WHAT TO DO IN CASE
OF AN EMPLOYEE
INJURY OR ILLNESS
d.) If an employee needs transportation upon discharge from the medical facility, he/she may use a taxi service or family
member for transportation home or back to the work site depending on the discharge instructions and employee's
desires. The cost of a taxi will be reimbursed if the injury is found to be work related. An employee should request a
receipt from the taxi service.
MEDICAL RELEASE TO WORK
1. When discharged from a medical facility, the employee will receive either discharge instructions or a work status form
concerning their return to work status. The employee is required to forward a copy of this documentation prior to returning to
work duty. This documentation can be submitted via fax to 530-898-5755, by email to [email protected], or in
person to the HRSC counter located at Kendall 220.
WORK-RELATED INJURIES OR ILLNESSES
1. Employees who become ill or are injured while performing work duties within the course and scope of their employment will
likely be covered under the Workers' Compensation program.
2. Reporting Requirements:
a.) REPORT THE ILLNESS/INJURY IMMEDIATELY TO THE EMPLOYEE LEAVES & WORKERS'
COMPENSATION UNIT, (530) 898-4670. If the work related illness or injury occurs after hours, a voice mail
message should be left which includes the employee's name, nature of the work related injury or illness, whether and
to what facility the employee was transported, and how the employee was transported (ambulance, Merit, other).
b.) Download the Work-Related Injury and Illness Incident Report (OSHA 301 Form). Follow the instructions listed at
the top of the OSHA 301 Form.
c.) Complete numbers 11 and 12 on page 3 of DWC-1 and provide the DWC-1 to the injured employee for completion of
numbers 1-6 and 8. Instruct the injured employee to return the completed form to Employee Leaves and Workers'
Compensation Unit, Kendall Hall 220 or via fax to (530) 898-5755.
If you are unable to provide the DWC-1 to the employee, call (530) 898-4760 immediately for mailing within 24
hours.
3. Accident Scene Investigation:
Once medical treatment and transportation have been secured, the ill or injured employee's supervisor or designee must survey
the accident scene.
When surveying the scene, the supervisor should note the following types of information which will help to complete the
OSHA 301 Form:
a.) Was equipment properly setup and being used properly? Were chemicals being used per instructions?
b.) Was the employee wearing proper clothing, footwear, and/or PPE?
c.) What external conditions (weather, uneven surfaces, distractions, etc.) may have influenced the employee or affected
the situation?
In the case of a serious accident, or any accident involving equipment, a supervisor should secure the scene and not otherwise
clean-up or disturb the area until Environmental Health & Safety (EHS) (x5126) or UPD (x5555) can document the scene and/
or conduct an investigation. EHS will conduct an investigation to meet the OSHA requirements. This investigation is not a
substitute for the supervisor completing the OSHA 301 Form.
ELWC-Procedures-for-Workplace-Injuries-Illness.pdf | Rev. 10/18/2016
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NON-EMERGENCY TRANSPORT
OF INJURED/ILL EMPLOYEE
(Request Form)
TRANSPORTATION TO BE PROVIDED BY:
Fax completed form to
Merit at (530) 893-8686
MERIT MEDI-TRANS
1355 E. Eaton Road, Suite A Chico, CA 95973
Phone: (530) 893-8790 - Fax: (530) 898-8686
DATE & TIME OF REQUEST:
@
A.M.
P.M.
VIA PHONE CALL
VIA FAX
IF YOU WISH CONFIRMATION OF REQUEST, YOU NEED TO PROVIDE YOUR
PHONE NUMBER:
FAX NUMBER:
TRANSPORT REQUESTED BY:
NAME
TITLE
PHONE
TRANSPORT REQUESTED FOR:
EMPLOYEE NAME:
TRANSPORT REQUIREMENTS:
Needs wheelchair
Gurney
Ambulatory with assistance
TRANSPORT LOCATION:
FROM:
PHONE#:
(campus location)
TO
IMMEDIATE CARE MEDICAL CENTER, INC.
376 VALLOMBROSA AVE
CHICO, CA 95928
ENLOE MEDICAL CENTER EMERGENCY SERVICES
1531 ESPLANADE
CHICO, CA 95926
BILLING INSTRUCTION FOR MERIT MEDI-TRANS: Please submit billing invoice and copy of this request form to:
California State University, Chico
Human Resources Service Center
Employee Leaves & Workers' Compensation
400 West First Street, Chico, CA 95929-0010
Phone (530) 898-4670 Fax (530) 898-5755
ELWC-Procedures-for-Workplace-Injuries-Illness.pdf | Rev. 10/18/2016
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