All Los Rios employees – including all regular, temporary, student help, and some students in unpaid on-the-job training programs – may be covered by Workers’ Compensation. When a work-related injury occurs, follow the Campus Workers' Compensation Checklist (PDF).

Report the Injury

To report the injury or illness appropriately, first figure out what type of injury or illness occurred:

Emergencies and Serious Work Injuries

If it is an emergency, then call the Los Rios Police Department at (916) 558-2221 and dial zero to connect to a dispatcher. You can also call 911 as appropriate (emergency medical services). After the emergency is stabilized, call Company Nurse at (888) 375-9780 to report the injury.

Serious work injuries generally mean those that:

  • Require hospitalization
  • Involve the loss of a body part
  • Involve serious permanent disfigurement
  • Are fatal

Within one day of notification of injury, the injured employee's supervisor must complete and submit the required forms. In addition, Cal-OSHA must be notified within a prescribed period of time. Immediately notify the vice president of administration or campus operations, so they can contact Cal-OSHA.

Non-Urgent Injuries

For non-urgent injuries or illnesses, employees or their supervisors should call Company Nurse at (888) 375-9780 to report the injury. Within one day of notification of injury, the injured employee's supervisor must complete and submit the required forms.

Minor Injuries

Minor injuries are those that require basic first aid and can be treated at the work site with no lost work time. Examples include minor cuts, scrapes, burns, and splinters. Minor injuries should be documented but do not need to be reported, unless either of the following occurs:

  • The injury worsens (for example, an infection or other symptoms develop) and requires additional medical treatment or lost work time
  • The employee completes Form DWC-1

If either of these happen, then follow the procedures for a non-urgent injury.

Reporting Forms

After calling Company Nurse, Company Nurse will partially complete the Employee’s Claim For Workers’ Compensation Benefits (Form DWC-1) and the Employer’s Report of Occupational Injury or Illness (Form 5020) and email/fax them to the campus and department. The supervisor then reviews the information, complete the forms, and forwards all three forms to the vice president of administration's office.

  • Form DWC-1 – In the Employer section, fill in lines 10 to 13. Copy and give the original form to the employee within one working day of receiving knowledge of a work-related injury. When the employee returns the completed form (lines 1 to 9), the supervisor completes lines 14, 17, and 18. Note: To file a work comp claim and seek medical treatment, the employee must complete the top section of the DWC-1 and return to their supervisor. Employee must file a claim form in order to use Workers’ Compensation as a reason for an absence.
  • Form 5020 – Complete the missing information, check for accuracy, sign, and date.
  • Supervisor's Report of Employee Injury Form (PDF) – Complete the form, including the specific steps that have been taken to prevent similar accidents (for example, provided training, repairs/maintenance of facilities, and so on) and sign.

Information for Injured Employees

Los Rios has elected to self-fund workers' compensation benefits required by the California Workers' Compensation law. This means that medical bills and all other benefits are paid directly with district funds. Your workers' compensation rights are completely protected. Download a Guide to Workers' Compensation Benefits (PDF) or continue reading for more information.

What to Do If You Are Injured at Work

Report all work-related injuries and/or illnesses to your supervisor and to Company Nurse at (888) 375-9780. If your supervisor is unavailable, then report your injury to your supervisor's superior.

For emergency situations, call Los Rios Police or 911. After the emergency situation has stabilized, call Company Nurse to report the injury.

What is Company Nurse?

Company Nurse is an injury management service that provides guidance for injured employees in obtaining the appropriate level of treatment. Company Nurse also initiates the reporting process.

File a Workers' Compensation Claim Form

Your supervisor will give you a claim form for workers' compensation benefits. You will need to provide a detail explanation of the incident that caused your injury. If you receive first aid treatment for very minor cuts, scratches, splinters, and so on – and no time is lost from work – then you do not have to complete a workers' compensation claim form.

Lost Time From Work

If you miss any time from work, then you must submit a doctor's authorization to your supervisor and attach a copy to your absence report. Absence without doctor's authorization cannot be charged to work-related injury leave. Please keep your supervisor informed on how long you will be off work or when you can return to temporary modified duty (restricted duty), as determined by your doctor

Get Medical Treatment

If you require treatment in addition to first aid, then you may go to any of the following designated medical facilities.

If you need treatment after the designated medical facilities have closed or for emergencies, then you may go to one of the designated hospitals. Once you are released from the hospital, you should obtain follow-up care from one of the designated medical facilities.

You may be treated by your own personal physician if you have a completed pre-designation of physician form on file with General Services (prior to the date of the injury).

Medical Clinics

Kaiser Occupational in Folsom

2155 Iron Point Road
Folsom, CA 95630
2nd Floor
(916) 817-5667
Monday through Friday, 8:30 am to 4:30 pm

Kaiser Occupational in Roseville

1600 Eureka Rd.
Roseville, CA 95661
Building 2C
(916) 784-4000
Monday through Friday, 8:30 am to 5:00 pm

Kaiser Occupational in Sacramento

2025 Morse Avenue
Sacramento, CA 95825
Across from main hospital
(916) 973-5499
Monday through Friday, 8:30 am to 5:00 pm

Kaiser Occupational in South Sacramento

6600 Bruceville Road
Sacramento, CA 95823
Medical Office Building 3, 2nd Floor Room 235
(916) 688-2005
Monday through Friday, 8:30 am to 5:00 pm

Med 7 Urgent Care Center

4156 Manzanita Ave., #100
Carmichael, CA 95608
(916) 488-6337
Daily, 9:00 am to 9:00 pm

Mercy Medical Group in Elk Grove

9394 Bighorn Boulevard
Elk Grove, CA 95758
(916) 691-8500
Monday through Friday, 8:00 am to 12:30 pm and 1:30 pm to 5:00 pm

Mercy Medical Group

1730 Prairie City Road
Folsom, CA 95630
(916) 351-4801
Monday through Friday, 8:00 am to 4:30 pm

Sutter Occupational in Natomas

1014 W North Market Blvd, Suite 20
Sacramento, CA 95834
(916) 565-8600
Monday through Friday, 8:00 am to 5:00 pm

Mercy Medical Group in Sacramento

3000 Q Street 4th Floor
Sacramento, CA 95816
(916) 733-3390
Monday through Friday, 7:00 am to 5:00 pm

Mercy Medical Group in Sacramento – Urgent Care After Hours

3000 Q Street 4th Floor
Sacramento, CA 95816
First Floor
(916) 733-3377
Monday through Friday, 5:00 pm to 7:00 pm; Saturday, Sunday, and holidays from 8:00 am to 4:00 pm

Sutter Occupational in Roseville

Three Medical Plaza, Suite 100
Roseville, CA 95661
(916) 797-4700
Monday through Friday, 8:00 am to 5:00 pm

Sutter Occupational in Roseville – Extended Hours

Three Medical Plaza, Suite 100
Roseville, CA 95661
Building #2, Suite 130
(916) 865-1400
Monday through Friday, 5:00 pm to 9:00 pm

Sutter Occupational in Sacramento

1201 Alhambra Blvd, Suite 210
Sacramento, CA 95816
(916) 731-7775
Monday through Friday, 8:00 am to 5:00 pm

Hospitals for After Hours or Emergency Care

Marshall Hospital

Marshall Way
Placerville, CA 95667

Mercy General Hospital

4001 J Street
Sacramento, CA 95819

Mercy Hospital of Folsom

1650 Creekside Drive
Folsom, CA 95630

Mercy San Juan Hospital

6501 Coyle Avenue
Carmichael, CA 95608

Methodist Hospital of Sacramento

7500 Hospital Way
Sacramento, CA 95823

Sutter Davis Hospital

2000 Sutter Place
Davis, CA 95616

Sutter General Hospital

2801 L Street
Sacramento, CA 95816

Who Pays for Medical Treatment?

All necessary bills related to your work-incurred injury or illness will be paid by the district, if you are treated by one of the designated facilities. Charges incurred at any other facility may not be paid by the district. Examples of covered expenses include:

  • Doctor and hospital bills
  • X-rays
  • Medication
  • Crutches or other accommodations needed to help you recover

You should not be billed for any medical service.


Additional Resources