• Risk Management

    Work Related Injuries

    Forms & Informative Documents

     

    Report ONLY Forms for Injuries / Incidents

    Sketch of a document with lines representing text Employee Incident Report Electronic Form (Only for SAUSD employees) - Click Here

    The purpose of this form is for an employee to report a work-related injury for which they DO NOT want medical treatment.  If the employee is seeking medical treatment for their work-related injury, please refer them to the InterAid Hotline Nurse, which they can call at 800-367-5020.  If you are having technical issues with completing this electronic form, please contact Risk Management at 714-558-5856 or RiskManagement@sausd.us.

    To report incidents/injuries that occurred to non-SAUSD employees (consultants, visitors, parents, etc.), use the Incident & Unusual Occurrence Report Form located further below.  

    Sketch of two documents with lines representing text Incident & Unusual Occurrence Report Form - Click Here

    This form can be used to report incidents involving property damage or incidents/injuries that occurred to non-SAUSD employees (consultants, visitors, parents, etc.) while at SAUSD premises. 

    DO NOT use this form to report an incident/injury that a student sustained at SAUSD premises and instead use the ASCIP - Confidential School Incident Report form (Click Here).

     

    All Work Related Injury Documents, Forms, & Notices 

    • DWC-1 Claim Form - Click Here
    • InterAID Nurse Triage HOTLINE Flyer - English  Spanish
    • InterMed Select MPN - English  Spanish 
    • Medical Mileage Expense Form for 2024- Click Here
    • Medical Mileage Expense Form for 2025- Click Here
    • Optum Temporary Rx Card, for workers' compensation prescribed medication. English  Spanish  
    • Pre-Designation of Personal Doctor Form -  DWC Form 9783  
    • Important Workers’ Compensation Information: Skelton vs. WCAB case - Information regarding medical appointments during working hours - Click Here
    • Chapter 1 - The Basics of Workers’ Compensation - Click Here
    • Chapter 2 - After You Get Hurt on the Job - Click Here

     

      

    Sketch of a red colored phone handle Our Contact Information

     

    Have Questions or Concerns? 

    Contact us.

     

    Workers' Compensation Administration

     

    Office Hours: Monday-Friday, 8 a.m. to 4:30 p.m. (Closed on Holidays)

    Main Line: (714) 558-5856    

    Fax: (714) 480-5320

    Email: RiskManagement@sausd.us

    Address: 1601 E. Chestnut Ave., Santa Ana, CA 92701