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Alameda County Law Library Building
125 - 12th Street, 3rd Floor, Oakland, CA 94607 · 510-272-6920

Risk Management Unit, a part of the CAO

Resources for Supervisors and Managers

A nurse-staffed injury hotline is available to assist you to report industrial injuries and initiate the filing of a workers' compensation claim.

The employee will still need to complete (and sign) a DWC-1 and return it to the supervisor, for scanning and e-mailing to the TPA.

The Form 5020 will be generated from the telephonic report, and a link to the nearly completed electronic form sent to the departmental workers' compensation liaison for review, completion of a few fields, and electronic submission to the TPA.

We encourage all departments to use this new, sustainable process.

In cases where it is not possible to report the injury through the hotline, forms may still be completed by hand and faxed to the TPA at 1-866-548-2637 or scanned and email to

Click on "Reporting an Industrial Injury" for information on this process and on obtaining medical treatment.

Roles and Responsibilities of a Supervisor and Manager:

Here are things to remember if an employee is reporting a work related injury or illness. Please click on the links below for the appropriate forms and instructions. 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.

The following resources provide you with general information on workers' compensation benefits and your responsibility as a department supervisor and manager.

Managing the Return to Work Process:

  • WORK STATUS REPORT (PDF - 156kb)*: For each medical appointment, the employee must bring this form to their medical provider and submit the completed form to his/her supervisor or acceptable alternative.
  • EFJA/EF5 (PDF - 517kb)*: This form is to be completed when requested by the claims adjuster to determine the injured employee's ability to return to work. Your claims adjuster can identify resources to assist you in completing the form.
  • Temporary Modified Work Policy (PDF - 132kb)*
  • Temporary Modified Work Plan (PDF - 97kb)*
  • TD/MODIFIED WORK TRACKING (XLS - 19kb)**: Use this form to track your employee's time off of work or modified work assignment.

Other Resources:

  • Claremont EAP
  • DESIGNATED PHYSICIAN AND MEDICAL FACILITY (PDF - 103kb)*: 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.
  • Ergonomic Evaluations: Depending on the type of injury, an ergonomic evaluation of the employee's worksite may be recommended. It is preferred that a preventive ergonomic evaluation be requested prior to an employee being injured. Extensive information on office ergonomics is available by clicking here.
  • Workers' Compensation Abbreviations and Acronyms (PDF - 122kb)*: Common abbreviations and acronyms used in Workers' Compensation claims.

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

** To view Microsoft Office Word, Excel, or PowerPoint documents, you can download a free trial version of Office 365. Per Microsoft, you will be able to continue viewing files even after the trial has expired.

*** Microsoft Excel (XLS) file requires the free Microsoft Excel Viewer.