Cal Poly Pomona
Human Resource Services
Administrative Affairs Division
Administrative Affairs Special Programs
PolyCARES (Violence Prevention)

Workers' Compensation

Workers' Compensation--What to Do If You Sustain an Injury or Illness Due to Work

Employee Procedures

Employees (including student assistants and volunteer employees) are encouraged to report injuries/illnesses when they occur. Find out more about what to do if you become injured or ill at work:

What to Do If You Sustain an Injury or Illness Due to Work (Printable PDF) New

Workers' Compensation Claim Form

Manager/Supervisor Procedures

How to Respond to and Report on Work-Related Injuries and Illnesses--The First 24 Hours (Printable PDF) New

Manager's/Supervisor's Procedures for Reporting Work-Related Injuries and Illnesses

Posting Notices New

Industrial Clinic Posting

Posting Notice

Form 300A Summary of Work-Related Injuries and Illnesses

Industrial Clinics

U.S. HealthWorks is the designated industrial clinic for Cal Poly Pomona employees.

  • For more information about U.S. HealthWorks visit their web site.


Medical Service Order

Manager's/Supervisor's Report of Employee Injury or Illness

Workers' Compensation Claim Form

Transitional Work Plan

Physician Pre-Designation Form

Additional Information

The California Department of Industrial Relations web site contains additional information on Workers' Compensation.

Department of Industrial Relations - Division of Workers' Compensation

Division of Workers' Compensation - I was injured at work

Questions and Contact Information

Risk Management is here to help you respond to workplace injuries. If you have any questions regarding the Workers' Compensation program, please contact Maribel Nerio, Workers' Compensation Coordinator at (909) 869-3725, or Valerie Eberle, Manager of Benefits, Workers' Compensation & Risk Programs, at (909) 869-4846.