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Procedures for Supervisors

For emergencies call 911 from any phone.  Other treatment options for the injured employee can be found on the Workers' Compensation website.

The clinics used by the University are:

Healthpointe at the following location.

290 N. 10th St. #100
Colton, CA 92324
(909) 264-2500 office
(909) 264-2510 fax

Kaiser on the Job at the following locations. 

Inland Empire Area

Fontana Medical Center Medical Office Building 2, 6th Floor

9961 Sierra Ave. Fontana, CA 92335

(909) 427-3917


Riverside Medical Center Medical Office Building 1, 4th Floor, Module 4J

10800 Magnolia Ave.

Riverside, CA 92505

(951) 353-4322

Healthpointe Medical Treatment Authorization

Supervisor's Injury Investigation Report for Employee Injury:

The supervisor completes the Supervisor's Injury Investigation Report for every reported employee incident or injury/illness occurring on-the job. It should be completed through a one-on-one discussion of the circumstances that caused the accident so that workplace conditions or work practices that contributed to the accident can be corrected. For guidance and to follow proper protocol, see the Injury Illness Reporting Flow Chart 2017 

  1. State of California "Employee's Claim for Workers' Compensation Benefits" - 
  2. The Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility must be given to the injured employee within 24 hours of the employer's knowledge of the injury/illness, according to state law. The form spells out the benefits an injured employee may be entitled to receive. To meet the time requirement, it may be necessary to mail the form to the injured employee. It is up to the injured employee to complete the form and return it to management, if medical treatment is necessary. Otherwise, it does not have to be returned.
  3. Personal Physician Designation Form if an employee pre-designates a treating physician, that physician has to have seen that employee within the last year and maintain some of the employee's medical records. This designated physician agrees to accept fees for services that are regulated by the Labor Code.
  4. Work Status (Doctor's Note) - This is the note from the treating doctor, clinic or hospital reporting on the injured employee's medical condition, required treatment and return to work status. The university requires a release from the treating doctor whenever an injured employee returns to work following an injury. Copies of the doctor's note(s) are supposed to be sent to your supervisor and Risk Management to verify time off for an injury and any limitations, or restrictions while on the job.