Reporting Hazards Accidents and Injuries

If Faculty and Staff is injured on the job, employees should report incidents to their supervisor and the Human Resources Department to fill out all necessary paperwork for work related injuries. If there is an immediate emergency, employees are to get the best treatment available and then report the injury to the appropriate supervisor and the Human Resources Department as quickly as possible.

Based upon the nature of the incident/accident, Risk Management will investigate and may provide recommendations or request repairs, notify insurers, and ensure full documentation of the incident for purposes of prevention of future injuries and for managing any claims that may result.

Students, visitors, and others should report incidents and/or accidents by contacting University Police at (661) 654-2667.  Students should report to the Faculty supervising during the time of the incident if the incident occurs during class or laboratory session.  Risk Management will follow up with the responsible University staff regarding the reported Accident/Incident.

Student and visitors should file a Campus Incident Report. Based upon the nature of the incident/accident, Risk Management will investigate and may provide recommendations or request repairs, notify insurers, and ensure full documentation of the incident for purposes of prevention of future injuries and for managing any claims that may result.

The driver of a University, State-owned, or rental vehicle involved in an accident will record all pertinent information on the Accident Identification Card, Std. Form 269 before leaving the scene of the accident. If another vehicle is involved, the appropriate portion of the Std. Form 269 will be detached and given to the driver of the other vehicle. Blank Accident Identification Cards should be found in the glove compartment of each University or State-owned vehicle, as outlined in Use of University and Private Vehicles Guidelines.

• Contact University Police at emergency line: (661) 654-2111 or non-emergency line: (661) 654-2677
• Notify your immediate supervisor

  

To submit a ServiceNow ticket, click the image above to request training, report a hazard, request an ergonomic evaluation, hazardous waste pickup, etc.

 

 

A claim against the California State University or one of its campuses must be filed with the CSU Office of Risk Management after the incident or event occurred, along with a $25 claim filing fee made out to “Trustees of CSU.” Completed claims must be delivered or mailed to:

The CSU Office of the Chancellor
Risk Management

401 Golden Shore, 5th Floor
Long Beach, CA 90802-4210

Be sure your claim is against the CSU, not another public entity. If the claim involves another state agency, the claim should be filed with the Department of General Services. If the claim involves a county, city or other local governmental entity or employee, the claim should be filed directly with the local city or county’s governing board or clerk.

1. Carefully read the instructions, complete the relevant sections of the CSU Claim Form describing the circumstances in full detail that led to the alleged damage or injury, and include any related supporting documents, such as police reports, medical documentation, estimates for repair, etc.
2. Make a copy of your claim package for your records and mail the original claim package with your payment of $25 (made out to “Trustees of CSU”) to the CSU Office of the Chancellor at the address above.
3. If you do not use the CSU Claim Form, you must provide sufficient information as provided below to process the claim and the request must be appropriately signed.
4. Under circumstances where you cannot afford to pay the $25 fee and you would like to request a fee waiver, you must attach an Affidavit for Waiver of CSU Filing Fee .
5. File the claim within the required time limits. For tort or personal injury claims, the claim must be filed within six months of the date of the incident. For contract claims, the claim must be filed within one year of the date of the alleged breach of contract.
6. If the claim-filing deadline has expired, you may seek permission to file a late claim, but that request must be made within six months of the missed deadline. You must then file an Application for Leave to Present a Late Claim to the CSU.

Claimants are not required to use the CSU Claim Form so long as they provide the following information:

1. The name and address of the claimant
2. The address to which the claimant desires notices be sent
3. The date, place and other circumstances which gave rise to the claim asserted
4. A general description of the loss incurred
5. The name or names of the CSU employee or employees causing the loss, if known
6. The amount claimed, including any estimated amount of prospective loss, together with the basis of computation for those amounts. If the amount claimed and/or the prospective loss is unknown, the claimant shall state whether those amounts are believed to exceed $25,000

The claim shall be signed by the claimant or by some person on his/her behalf and must be filed with the CSU Office of Risk Management within six months after the incident or event occurred along with a $25 claim filing fee made out to “Trustees of CSU.” Completed claims must be delivered or mailed to the address above.