Risk Management
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Risk Management
Work Related Injuries
Forms & Informative Documents
Report ONLY Forms for Injuries / Incidents
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.
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
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