MY FPM

Cal-OSHA regulations require employers to report any work-related serious injuries or illness immediately, but no longer than 8 hours after the employer has been made aware. Serious injuries and illness are defined as any hospitalization for a period more than 24 hours for other than medical observance, loss of any member of the body or any serious degree of permanent disfigurement.

1. Managers Report of Incident Form

Complete Managers Report of Incident Form

2. Workers Compensation Claim Form

Workers Compensation Claim Form
Declination of Medical Treatment

3. Broadspire Disability Claims

Please call 800-495-2315

Approved Medical Facilities

4. Incident Investigation Form

Incident Investigation Report

5. EH&S Guidelines

ehs.usc.edu/occhealth/injury-prevention

Contact

Gary Pons, Chief Safety Officer of FPM

:  (213) 740-3069     :  (714) 519-4812     : gpons@usc.edu