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SULAIR Human Resources

Workers' Compensation Procedures

Step One:

Employee and/or supervisor must contact Library Human Resources (HR) at 3-8251 or Green Library, Room 241D.

Step Two:

Employee and supervisor completes two forms and return to Library HR. Both forms are available from HR or by clicking on the below link.

SU-17 (Accident/Incident/Exposure Report) - The top portion of this form is to be completed by the employee and the bottom portion is to be completed by the employee's supervisor. This form must be returned to HR within 24 hours. (This is the only form that needs to be completed if you are not going to seek treatment from a physician or did not miss any days from work.)

DWC-1 (Employee's Claim for WC Benefits) - Supervisors refer to the instruction page when completing this form. Make a copy of the pre-filled DWC-1 before giving to employee. This form must be provided to the employee within 24 hours of the workplace injury/illness. The employee must complete and return if they receive medical attention or miss any days of work.


Step Three:

Life-Threatening Emergency Care: For immediate life threatening injuries go to the nearest emergency facility (e.g. Stanford Univeristy Hospital Emergency Room, 650-369-5811) or dial 911 or 9-911 from campus phones.

Non-Life Threatening Care: Unless the employee has pre-designated a physician to treat them for work-place injuries/illnesses, the employee must seek treatment through the Stanford Occupational Health Center (SUOHC). The SUOHC is located in the Environmental Safety Facility (ESF) at:

480 Oak Road, Room B15
Stanford, CA 94305-8007
Phone: (650) 725-5308
Fax: (650) 725-9218
*Make sure to bring your Stanford ID card.

Monday – Friday
8:00 am - 5:00 pm

There is a "C" lot in front of the ESF and on adjacent streets.
Visitor pay parking is also available ($0.25 per 10 minutes, limit 2 hours, until 4:00 pm)

Visit the Stanford University Occupational Health Center website for more information.

Employees in the SAL3 Livermore department may seek treatment from Nord, Stephen R., MD, Premier Comp Medical Group, Occupational Medicine, 5635 W Las Positas Blvd, 401 Pleasanton, CA 94588, (925) 520-0055.


Step Four:

After seeking medical treatment, send the Work Status Report to Library HR, Green Library, Rm 241D, MC 6062 or fax to 650-725-0743. The Work Status Report may indicate work restrictions. Both HR and the supervisor will review the form, however, the supervisor must decide whether the department can or cannot accommodate the doctor's orders. If the restrictions are not accommodated, the employee will remain at home and receive disability benefits.


Step Five:

Employee and supervisor must keep track of hours missed and enter into Kronos. The employee does not need to enter time off for the initial appointment when seeking medical treatment. However, the employee must use acrrued time-off for follow-up visits if the employee cannot schedule appointments before or after work hours.


Miscellaneous Notes:

For full-time “regular staff” (temporary, casual, and student employees are not eligible), each "approved" WC injury is given forty (40) "free" hours to use. These hours can only be used when the absence is authorized by your WC doctor. This means the employee's leave hours are NOT used. These forty hours can be used over time or consecutively. (Pro-rate hours if employee is not full-time.)

For ergonomic injuries, check the box "Request Workstation Evaluation" when completing the SU-17 Accident/Incident Report. You will also need to complete the Computer Workstation Ergonomics Trainging course, EHS-3400. Information for this course is found at

If you are filing a claim for work-related mental stress or psychiatric disability, please contact your personal physician for a referral.

Our workers' compensation insurance administrator is Zurich North America, P.O. Box 7774, San Francisco, CA 94188-7744, (415) 538-7100 or (800) 701-4926.


Last modified: January 13, 2009

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