IUSD Workers’ Compensation Procedure


When an employee is injured, please have them contact Company Nurse at 1-877-230-9693.

⮚ Print out and give the employee the State of California Workers’ Compensation Claim
Form (DWC-1) within 24 hours of the work related injury or illness.

⮚ Print out and give the employee the Temporary Prescription Services ID Card.

⮚The supervisor will need to complete and sign the Supervisor’s Accident Report. Please forward the
completed document to Risk Management & Insurance for further handling.

Email the Supervisor’s Accident Report and DWC-1 Form to Risk Management & Insurance at
RiskManagement@iusd.org with the original forms mailed to the Risk Management & Insurance
Department. All forms are located on the Intranet under Business Services – Risk Management
– Workers’ Compensation.

If an employee sustains a work related injury and is not referred for medical treatment by Company
Nurse or refuses medical treatment, the completed Supervisor’s Accident Report will still need to
be submitted to Risk Management & Insurance.

The employee has the option to see their own doctor for a work related injury only if the employee
completed the required Pre-Designation of Physician Form PRIOR to the reported

Effective July 1, 2019

Kaiser Permanente On-the-Job
6670 Alton Parkway
Irvine, California 92618
(714) 644-6450

Sand Canyon Urgent Care
15775 Laguna Canyon Road, Suite 100
Irvine, California 92618
(949) 417-0272

District Contact
Laura Horning, Workers’ Compensation/Benefits Specialist

(949) 936-5267 – Office
(949) 936-5019 – Fax

IUSD Workers’ Compensation Trends – Power Point Download