Report an Injury electronically using:
 

INCIDENT REPORTING TOOL  

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Fill out a claim form DWC-1 https://www.dir.ca.gov/dwc/dwcform1.pdf 
Complete the first 9 lines only of the form, we will fill out the rest for you.  When completed and signed, send to: Email: workerscomp@ucr.edu or Fax: 951-827-3202

EMPLOYEE INJURY REPORT FORM

When completed send to: Email: workerscomp@ucr.edu or Fax:  951-827-3202 

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Fill out a claim form DWC-1 https://www.dir.ca.gov/dwc/dwcform1.pdf 
Complete the first 9 lines only of the form, we will fill out the rest for you.  When completed and signed, send to: Email: workerscomp@ucr.edu or Fax: 951-827-3202 

Call: 1-877-682-7778 

- And -

Fill out a claim form DWC-1 https://www.dir.ca.gov/dwc/dwcform1.pdf 
Complete the first 9 lines only of the form, we will fill out the rest for you.  When completed and signed, send to: Email: workerscomp@ucr.edu or Fax: 951-827-3202