In Case of Workplace Injury:
#1 - Reporting Injury or Illness
Report the injury or illness to your supervisor or Human Resources department (if supervisor is not available) so you can secure medical care. If your injury or illness developed gradually (like tendentious or hearing loss), report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care.
#2 Securing Medical Attention
Supervisor and injured employee should place call to "Company Nurse" our injury contact center as soon as possible. Company Nurse will gather information regarding the incident/injury and then assist the injured workers access appropriate medical treatment.
Company Nurse Contact Information (Available 24 Hours a Day)
Phone #: 1-877-518-6702
Employer Name: Monterey Peninsula Community College District
Search Code: NCC05
Important Notice: In case of life or limb threatening injury, dial 9-1-1. Get emergency treatment if needed. Tell the medical staff that your injury or illness is job-related.
#3 Completing Worker's Comp Forms
Most departments should have "Workers Compensation Packets" with required forms and documents.
DWC-1 Form: This form is used to request workers’ compensation benefits. In order to receive non-emergency medical care following an industrial injury/illness the attached DWC-1 form will need to be completed by employee and employer. Employee completes sections 1 thru 9 and Employer (Human Resources/Benefits Analyst) completes sections 10 thru 19. Return completed form to Human Resources/Benefits Analyst via email or in person.
Incident Report Form: Supervisor completes form. Both supervisor and employee sign and date form.Attach
any written statement by injured employee or witness(es), if provided
Return completed form to Human Resources/Benefits Analyst via email or in person.
Supervisor's Accident Investigation Form (Appendix A): Supervisor completes form in as much detail as possible. Use Appendix B as a reference guide/checklist if needed. Return completed form to Human Resources/Benefits Analyst via email or in person.
#4 Additional Documents
The employee should also be provided with the following forms:
- Workers' Compensation Medical Provider's List
- Workers’ Compensation Temporary Prescription ID Card
- Important Information about Medical Care if you have a Work-Related Injury or Illness (English/Español)
- Notice to Employees (English/Español)
- Covered Employee Notification of Rights Materials: PRIME Advantage-Medical Provider Network ("MPN")
Worker's Compensation Medical Providers
Hospitals
Community Hospital of Monterey Peninsula
23625 WR Holman Highway
Monterey, CA 93940
Ph: (831) 624-5311
Fax: (831) 622-2648
Clinics
Doctors-on-Duty - Marina
3130 Del Monte Boulevard
Marina, CA 93933
Ph: (831) 883-3330
Fax: (831) 883-3335
Doctors-on-Duty - Monterey, Fremont Blvd.
2260 North Fremont Blvd.
Monterey, CA 93940
Ph: (831) 372-6700
Fax: (831)373-6234
Doctors-on-Duty - Monterey, Lighthouse Ave.
501 Lighthouse Ave
Monterey, CA 93940
Ph: (831) 649-0770
Fax: (831) 649-0142
Doctors-on-Duty - Salinas, South Main
31212 South Main Street
Salinas, CA 93901
Ph: (831) 422-7777
Fax: (831) 422-0136
Doctors-on-Duty - Watsonville
1505 Main Street
Watsonville, CA 95076
Ph: (831) 722-1444
Fax: (831) 722-4414
Concentra Urgent Care - Gilroy
190 Leavesley Road, Suite 102
Gilroy, CA 95020
Ph: (408) 848-0444
Fax: (408) 848-0443
Additional Forms and Documents