At Cal Poly Pomona, all employees are strongly encouraged to report work-related accidents and/or near miss incidents to their manager or supervisor when they occur. Early reporting will assist in identifying and addressing any safety related concerns. It will also assist in determining your eligibility for benefits and providing those benefits in a timely manner.
In the event of a medical emergency, dial 9-1-1 from any campus phone to contact University Police. Please keep in mind, dialing 9-1-1 from a cell phone will place the call to the California Highway Patrol, not to University Police. To call the University's Police Department Dispatch Center directly, dial (909) 869-3070.
The campus police dispatcher will send the appropriate personnel. Some examples of a medical emergency are: excessive bleeding, broken bones, loss of consciousness, and severe chest pain. When in doubt about the severity of a medical emergency, always dial 9-1-1 from any campus phone to contact University Police.
If an injury or illness requires only "first aid" treatment, such as removing a splinter or the treatment of minor cuts and abrasions, employees can receive treatment at the University's Student Health Services. Department offices should have a first aid kit available for minor injuries that do not require the assistance of a health care professional.
Student Health Services
Urgent Care extension: 2740
Clinic Hours:
If an injury or illness requires medical treatment beyond first aid, and you are unable to drive, unable to arrange timely transportation to your pre-designated physician, or you have not pre-designated a physician, you will be referred to one of the following U.S. HealthWorks locations. If transportation is needed to the clinic, please contact Risk Management at extension 3725.
Prior to going for treatment or evaluation at the University's Student Health Services, or U.S. HealthWorks, you should obtain a Medical Service Order form from your manager or supervisor. This form lets the medical facility know that you are being seen for a work-related injury or illness.
For all injuries/illnesses, please work with your manager or supervisor to complete the information and answer the questions on the Manager/Supervisor Report of Injury/Illness form.
If an injury or illness requires more than first aid treatment, your manager or supervisor should provide you with a Workers' Compensation Claim Form. Complete and sign the Employee portion of this form.
Return all of the completed forms to your manager or supervisor. These forms are available in your department office and/or by calling Risk Management at extension 3725.
All claims are submitted to the University's workers' compensation claims administrator, Sedgwick Claims Management Services. An account representative of Sedgwick CMS will contact you and may ask some questions about your injury/illness. They will also respond to any questions or concerns you may have about your claim. If you have any question related to the claims administrator, please contact Risk Management at extension 3725.
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 enclosed for your convenience. If you choose to pre-designate, please follow the directions to complete the form and return it to Risk Management, CLA Building 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.
Risk Management is here to help you through these various situations. If you have any questions regarding the Workers' Compensation program, please contact Victoria Lieding, Workers' Compensation Analyst, extension 3725, or Valerie Eberle, Manager of Workers' Compensation & Risk Programs, extension 4846.
