Overview
Workers’ compensation is a state-mandated, employer-paid benefit for employees who sustain occupational injuries or illnesses while working for or on behalf of Peralta Community College District.
In the case of a life-threatening injury, call 911 before completing forms
- Follow the Employee Workplace Injury & Incident Reporting Procedures
- Company Nurse For Injured Employee, Medical Provider Network, Mitchell First Program
- Workers’ Compensation Claim Forms
- Workers’ Compensation information
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Forms & Documents
- Company Nurse
- 24/7 Company Nurse gathers information and helps the injured worker access appropriate care. The injured worker notifies the supervisor of the outcome of the call.
- Approved Clinics
- If treatment is required, you may choose from the following care facilities
- Prime Plus – English | Spanish
- Your employer has selected Prime Plus as your medical provider network (MPN) to provide you with the choice of a broad scope of medical services for work-related injuries and illnesses.
- Cadence Rx – English & Spanish
- Cadence Rx assists you in obtaining prescription drugs related to your workers' compensation claim.
- Temporary prescription card
- Notice to Employees – English | Spanish
-
Insurer (Keenan) information about Workers' Compensation claims.
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- Employee Statement of Occupational Injury or Illness
- Supervisor Statement of Occupational Injury or Illness
- DWC1 – Egnlish & Spanish
- Use the attached form to file a workers’ compensation claim with your employer.
- DWC7 – English & Spanish
- Notice to Employees – Injuries Caused By Work






