Workers' Compensation

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 (PDF)

Workers' Compensation Claim Form (PDF)

Manager/Supervisor Procedures

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

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

Posting Notices

Industrial Clinic Posting (PDF)

Notice to Employees - Injuries Caused by Work - DWC 7 (PDF)
(Posting Notice)

Form 300A Summary of Work-Related Injuries and Illnesses (PDF)

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.

Physician Pre-Designation

Employees have the option of pre-designating their personal physician as their treating physician in the event of a work-related injury/illness. This designation must occur prior to a work-related injury/illness and your physician must agree to be pre-designated. Employees bear the responsibility of keeping their physician pre-designation current. A copy of the "Notice of Pre-Designation of Personal Physician" form is attached for your convenience. If you choose to pre-designate, please follow the directions to complete the form and return it to Workers' Compensation, CLA Bldg. 98, Room B1-35.

Note: "Personal Physician" includes a medical group, if the medical group is composed of licensed doctors of medicine or osteopathy operating as a multi-specialty medical group providing comprehensive medical services predominantly for non-occupational illnesses and injuries (for example, Kaiser).

An orthopedic specialist or specialty group cannot be pre-designated.


Note: Do not email or fax any documents that contain Social Security numbers or any other personally identifiable information.  Please either hand-deliver or send confidential documents through the Campus interoffice mail.

Medical Service Order (PDF)

Manager's/Supervisor's Report of Employee Injury or Illness (PDF)

Workers' Compensation Claim Form (PDF)

Transitional Work Plan (DOC)

Physician Pre-Designation Forms

Workers' Compensation Benefits

Workers' Compensation Benefits - Workers' compensation benefits are designed to provide you with the medical treatment needed to help you recover from your injury or illness caused by work; payment of temporary disability benefits if you lose wages because your injury prevents you from doing your usual job while recovering; payment of permanent disability if you don’t recover completely; and for certain types of injury, supplemental job displacement vouchers to pay for re-training should you be unable to return to work for the same employer.  More information is available through the California Department of Industrial Relations (Calif. Division of Workers' Compensation) at:  I Was Injured At Work.

Additional Information

    • The IDL benefit is equivalent to the full amount of the injured employee's salary for the first 22 days of the work-related injury or illness (a three day waiting period may apply).
    • Thereafter, IDL benefits will be equivalent to two-thirds of the employee's salary, payable for the next 11 months of disability.
    • An eligible employee may receive IDL payments for a period not to exceed 52 weeks within two years from the first day of disability.
  • CSU Enhanced Industrial Disability Leave (IDL) Program (Unit 8) - The Enhanced Industrial Disability Leave (EIDL) Program is a wage continuation program, in lieu of Workers' Compensation Temporary Disability (TD) benefits for eligible Public Safety employees who have suffered a work related injury or illness (some restrictions, including a three day waiting period, may apply).  Currently, only sworn Public Safety (Unit 8) employees are eligible for EIDL benefits. Please note, Public Safety Public Chiefs and Lieutenants are not eligible for this benefit.     

Questions and Contact Information

University Workers' Compensation is here to help you respond to workplace injuries. If you have any questions regarding the Workers' Compensation program, please contact Larissa Brewer, Workers' Compensation Coordinator at (909) 869-3725.