Employee - Become ill and injured on the job? Workers' Compensation - What to do (PDF Document)
Supervisor - Do you have an employee who became ill or injured while on the job? Workers' Compensation - What to do (PDF Document)
The DWC1 is a form that is to be completed by the ill/injured worker and the supervisor, Employee, please complete the "Employee" section of this form and return it to your supervisor. Supervisor, please complete the "Employer" section of the DWC1 form, once you receive it back from the injured worker. Immediately call Sedgwick at 1-855-572-5966 to open a claim. Then forward to HR by FAX: 888-609-3904 or by Email: email@example.com.
For complete information about a workers' compensation, please click on the Workers' Compensation - What to do slideshow. (PDF Document)
Workers' Compensation Claim Form (DWC 1) and Notice of Potential Eligibility
Fax: (888) 609-3904
Fax: (888) 502-9698
Northern California Conference of Seventh-day Adventists | 401 Taylor Blvd. | P.O. Box 23165 | Pleasant Hill, CA 94523 | (925) 685-4300 | firstname.lastname@example.org