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Workers' Compensation Reporting Process and Forms

California law guarantees certain benefits to employees who are injured or become ill because of work performed in the course of the job. Some of the benefits are medical care, payment for lost wages, and rehabilitation.

Pre-designation Form: Personal Physician (pdf fillable)

Employees who pre-designate a Personal Physician can receive treatment from their pre-designated Personal Physician - if the pre-designation is provided in writing, to the District before experiencing a work related injury. Employees who do not pre-designate a Personal Physician may seek treatment from one of the Panel Providers listed below.

Panel Providers (in order of closest proximity to the District):

Pinnacle Health Care (locations in Salinas, King City, Hollister, and Watsonville)
- See the Pinnacle Patient Survey here

WorkWell Medical Group (locations in Salinas and King City)
Doctor's On Duty (locations in Salinas, Marina, Seaside, Monterey, and Watsonville)

Workers' Compensation Reporting Process (PDF)
Forms embedded in above Reporting Process, individually linked:

Supervisor's Accident/Injury Report Form (pdf fillable)
Employee Claim Form for Workers' Compensation Benefits (pdf fillable)
New Hire Informational Brochure - English (pdf)
New Hire Informational Brochure - Spanish (pdf)

Additional information from Dept. of Industrial Relations:

Information and Assistance: How to file a claim (pdf)

Webpage last updated: 04/23/2014