Company Nurse Injury Hotline: 1-877-518-6702

24/7/365 Toll-free Injury hotline to report all workplace injuries 

Workers Comp Forms Available Here.

Instructions for Injured Employee

All incidents/injuries MUST be reported to Site Supervisor

1. You must call Company Nurse at 877-518-6702. Use the Search Code SIG05 to speed up the intake process. Please document your call confirmation/reference number.

Possible Outcomes from the call:

○ Self-Care or basic first aid, or

○ Referral to a medical facility by a Nurse

2. If you do NOT want medical treatment at this time, this does not give up your right to seek medical treatment at a later date should the need arise. If your symptoms worsen and you want medical treatment at a later date, simply call Company Nurse and get a referral to a medical facility.

3. If you get a referral from Company Nurse for medical treatment, contact Concentra to schedule an appointment. Once you have an appointment, contact Risk Manger so an authorization to treat can be submitted.

Concentra, Santa Rosa

1221 N. Dutton Ave

Santa Rosa, CA 95401

(707) 543-8360   

In case of an emergency:

Ukiah Valley Medical Center Emergency Room

275 Hospital Drive

Ukiah, CA 95482

Main Phone Number:  (707) 462-3111

4. The medical facility will provide you with a doctor’s note, “Work Status “, or ER Discharge papers after the initial visit. You must bring medical paperwork to the Risk Manager at the District Service Center on the same day as your medical appointment. Do not use District Mail.

o The Risk Manager will provide you with an Employee Claim Form(DWC-1), Workers’ Compensation Temporary Prescription ID Card, and PRIME ‘Important Information about Medical care if you have a Work-Related Injury or Illness” after you have seen a medical provider.

o The Risk Manager will coordinate with you and your Site Supervisor to determine whether UUSD can accommodate your restrictions if any are given.

o If you have restrictions or have been put off work, your Return to Work must be approved by the Risk Manager or an Interactive meeting PRIOR to your return to work.

o Employee will need to bring any/all Work Status notes the same day as the follow-up appointment to the Risk Manager at the District Service Center.

o Employee may be assigned Work Safety Video(s) to view through their Keenan Safe Schools account.

o Employee and Risk Manager will communicate/work together to return employee to pre-injury health status.

Contact the Risk Manager Kimberly Larkin with any questions.

[email protected]

(p) 707-472-5014

(f) 707-468-3454