Workers' Compensation

WORKERS' COMPENSATION FORMS AND INFORMATION

Workplace Injury Reporting Procedures Flowchart

Company Nurse (888) 770-0929 Search Code: BPUSD

TREATMENT FACILITIES:

Baldwin Park Area
Proactive Work Health
502 S. Garvey Ave
Pomona, CA 91766
909-620-8887
Hours: Monday - Friday 8 am - 5 pm

Tri-Cities Area
Akeso Occupational Health (North)
11817 E. Telegraph Rd.
Santa Fe Springs, CA 90670
562-949-9328
Hours: Monday - Friday 7 am - 7 pm

Tri-Cities Area
Akeso Occupational Health (South)
13440 E. Imperial Highway

Santa Fe Springs, CA 90670

562-926-3440
After Hours/Emergency Care

DWC-1
RM-3 Employee Incident Report
RM-4 Supervisor's Report
RM-5 Witness Statement
INDUSTRIAL ACCIDENT PROCESS- Classified
INDUSTRIAL ACCIDENT PROCESS- Certificated
INDUSTRIAL ACCIDENT PROCESS - Exempt Employee
INDUSTRIAL ACCIDENT PROCESS - Substitute Employees
Medical Provider Network Brochure - English
Medical Provider Network Brochure - Spanish
Mitchell Script FIRST FILL – Temporary Prescription Card (Eng)
Mitchell Script FIRST FILL – Temporary Prescription Card (Span)
First Medical Authorization (Only if Company Nurse is unavailable)