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Alameda County, CA,

Resources for Injured Employees

NEW!!! Effective July 1, 2013, Alameda County is switching to York Risk Services Group as its Workers’ Compensation TPA and implementing a nurse-staffed injury hotline to report industrial injuries and initiate the filing of a workers’ compensation claim. Our new claims system is paperless.

If you are injured on the job, CLICK HERE for information on reporting your injury and obtaining medical treatment, effective July 1, 2013.


Forms Needed if Injury Requires More Than First Aid Treatment

  • DWC1 FORM (PDF - 148kb)*: Complete this form if your physician indicates that your injury requires medical treatment beyond first aid or certifies disability beyond your work shift at the time of your injury. Complete the employee section of this form and submit to your supervisor.
  • FIRST FILL PHARMACY FORM (PDF - 437kb)*: Give this notice to any pharmacy listed on the form to expedite the processing of your prescriptions.
  • WORK STATUS REPORT (PDF - 156kb)*: Bring this form to each medical appointment. Your medical provider must complete at every appointment, and you must provide a copy to your supervisor/WCL.

General Information on Workers’ Compensation Benefits

Other Resources

  • Claremont EAP offers services that may be helpful for employees who are dealing with an occupational injury. Services are confidential and in most cases free to Alameda County, within service level limits. You may also contact Claremont EAP 24 hours a day, 7 days a week at 1-800-834-3773.
  • DESIGNATED PHYSICIAN AND MEDICAL FACILITY (PDF - 179kb)*: For non-emergency treatment, Company Nurse will direct the employee to go to an approved occupational health facility, unless they have pre-designated a physician prior to an injury. Even with a pre-designated provider, an employee may either go to that provider or an approved occupational health facility.

Mileage Forms

If you have to travel to get treatment for your work injury, you are entitled to re-payment of your travel costs. Please use correct form based on travel dates. For travel before 01/01/2015, please contact the third party administrator.

Your workers' compensation liaison can guide you through the process, or call the Risk Management Unit at 510-272-6920 or tie-line 2-6920.

* Portable Document Format (PDF) file requires the free Adobe Reader.

** Microsoft Word (DOC) file requires the free Microsoft Word Viewer.

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