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Workers Compensation Info

Worker's Compensation Administrator

Keenan & Associates

2882 Prospect Park Dr., Ste. 200

Ranco Cordova, CA 95670

 

P.O. Box 1538

Rancho Cordova, CA 95741

916-859-7160

916-859-7166 fax

 

Claims Examiner: Cheryl McKimmy

Claims Analyst:  Dana Stone

 Link to their website:  Keenan & Assoc.

What Do I Do If I'm Injured At Work?

 

IF AN EMERGENCY CALL 9-1-1

 

Please notify Shannon 14118 or Sheryl 14119 in the district office of all work injury/incidents

 

First Step:  Complete  Colusa USD W/C Incident Report 

This must be completed for any employee injury.  Its purpose is to document the incident and assess what can be done to ensure this won’t happen again. 

If employee chooses to seek medical treatment; obtain the 3 page (plus map) injured employee kit from your site office or supervisor.  The kit will include: Treatment Referral FormOccupational Health Authorization FormOccupational Health Map, and Express Scripts- Temp Prescription with you.

  • Treatment Referral Form:The employee is to fill out the EMPLOYEE SECTION then give to the Medical Provider to determine upon treatment if the injury is FIRST AID or REPORTABLE CLAIM.  The medical provider will mark their section then fax to me. 
  • Occupational Health Authorization Form: Supervisor to check W/C box, list date of injury, check IS AVAILABLE for modified work then sign the bottom in the authorization area.  Present this form to Rideout Health/Occupational Health upon arrival.
  • Express Scripts- Temp Prescription: Should a prescription be given from visit, fill out bottom right hand corner and give to pharmacy as payment.  Employee should not have out of pocket cost.

After medical visit submit the following to Shannon or Sheryl to district office:

  1. All paperwork given to you from the medical visit (work status summary)
  2. Any paperwork from follow-up appointments

These reports are important for the school district to determine modification of duties.  Further forms such as a DWC-1 may need to be completed at this time.

    2If employee chooses to NOT seek medical treatment:

  • Sign and date the bottom of Incident Report
  • Give report to site administrator or supervisor