Form

Instructions

Campus

UC Davis Workers' Compensation For the Davis campus: The link at the left leads to Safety Services, where you will find Workers' Compensation forms, information and assistance. UC Davis
Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility For the Health campus: Complete this form to file a workers’ compensation claim with your employer.
Submit to: Workers' Compensation, Fax: 916-734-2484
UC Davis Health
Workers' Compensation Departmental Injury/Illness Worksheet For the Health campus: Complete this form to file a workers’ compensation claim with your employer.
Submit to: Workers' Compensation, Fax: 916-734-2484
UC Davis Health