Workers Compensation


If you are injured, tell your supervisor immediately. 

You must report any injury to your supervisor within 24 hours, no matter how small the injury may seem.  Any delay in reporting may delay or bar your workers’ compensation benefits.You will need to tell your supervisor:  

  • when and where the injury occurred,  

  • what happened, and  

  • if anyone witnessed the injury 

  •  Your supervisor will complete a Supervisor Injury Report.  If medical treatment is needed you will be sent to an approved Occupational Health Provider.  A Workers Compensation Claim form will be provided to the injured employee.  The Workers’ Compensation Specialist, in turn, will report the injury to our claims administrator, Sedgwick Claims Management Services.  The system works best when paperwork is completed promptly, medical appointments are kept, and supervisors and the CSU Channel Islands Workers' Compensation Specialist are kept informed. The Worker’s Compensation benefit system is a team effort.  

Staff, Faculty, and Student Employees, to report a new injury, please report injury to your supervisor who will then communicate with the Workers’ Compensation Specialist who will administer the below forms : 

  • Supervisor's Injury or Illness Report 

  • Workers’ Compensations Claim Form  

Related Documents & Resources

Supervisors and Managers: Workers' Compensation Guide 

The Workers Compensation Specialist will reach out to the employee directly for form completion.

The following form is located under the Attachments section in the lower right corner of this service page.

  • Predesignation of Personal Physician


Use the "Submit HR Ticket" button to schedule your consultation and to complete required documentation.

Submit HR Ticket


Service ID: 49617
Tue 3/23/21 6:04 AM
Wed 5/26/21 1:38 PM