Supervisor's Report of Injury

Human Resources and Academic Personnel Services

Supervisor's Report of Injury is due in HR within 24 hours of injury. Any delay is not beneficial to the employee. If you are not sure whether this form should be submitted, please contact HR for further instruction.

In addition to this form, employee's should complete the DWC-1. More information regarding the Workers' Compensation process may be found on the HR website:

Routing Instructions: 

Please email to Torie Mather ASAP or fax to 707-826-3625. Do not put in campus mail without HR approval.