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Workers' Compensation

Workers' Compensation and MSJC

It is the District's goal to maintain a healthy and safe workplace; there are occasions where an employee experiences an occupational injury or illness.

Please take the following steps in reporting any injury or illness while at MSJC.

For Employees: If there is a life threatening injury or illness, call 911 (from a District phone dial 8-911).

If not life threatening, please do the following:

  • Report ALL workplace injuries/illnesses immediately to your direct supervisor and call S1 Medical at 1-833-691-9022. If your supervisor is not available, report to the next available supervisor and/or Nicole Piña, Director of Regulatory Compliance, via email at or via phone at 951-801-4413
  • Obtain a Treatment Referral Form and directions to the closest clinic from Risk Management.
  • Complete the Incident Report Form and submit a copy to Risk Management.

The following forms will be given to you. Please complete or review and then return to Risk Management.

MSJC Instructions for Injured Employee (Review)
MSJC Injured Employee Statement pdf fill (Complete)
MSJC DWC1 (Complete)
MSJC MPN Signature Receipt (Complete)

MSJC Covered EE Notification of Rights Materials (Review)

If the injury requires follow up appointments, it is the employee’s responsibility to submit Disability Status Reports to the supervisor.

The District’s return to work program provides for opportunities for injured employees to return to work with medical restrictions as outlined by the treating physician. An important part of recovering from an injury is returning to work. The transitional modified/alternate duties are allowed for up to 60 business days.

Please review our FAQs regarding workers compensation and if you have any questions, please contact Nicole Piña via email at or via phone at 951-801-4413.

For Supervisors: If an employee is experiencing a life threatening injury or illness, call 911 (from a District phone dial 8-911).

Upon notification of an employee injury or illness, complete the Treatment Referral Form and print directions for employee.