Home
Worker's Compensation

A safe working environment is a high priority for the Temecula Valley Unified School District.  However, should you become injured or ill, as a result of your job, we want to ensure you receive prompt, quality medical treatment.  Using the links provided in the section below will provide you and the appropriate site personnel with the information and documents each of you will need if you are injured at work. 
 

What To Do When An Employee Is Injured At Work

documents and forms

Employee's Statement - Decline Medical -  form to be completed by injured employee (no medical treatment necessary) and signed by a site representative.  No other forms need to be completed if the injured employee does not wish to seek medical treatment.
 


For injured employees wishing to seek medical treatment, please complete all the forms listed below.  Copies of the Instructions for the Injured Worker, Employee Rights, and Notification of Potential Eligibility, along with a copy of the completed forms, should be provided to the injured emoployee.

physician pre-designation

If you wish to have your primary care doctor treat you in case of a work-related injury, please print the form below and follow the instructions.  Your primary treating physician must put in writing his/her willingness to treat you under the workers' compensation regulations.  The doctor may use the form below, his/her letterhead, etc.

 

The completed form or letter must be on file prior to your injury for the pre-designation to be in effect.

Pre-Designation Form - English

Pre-Designation Form - Spanish

new hire documents

General Responsibilities - all new employees are required to print, complete/sign, and return to Risk Management.

New Employees are responsible for reading the notifications listed below:

Time of Hire Pamphlet (English)

Time of Hire Pamphlet (Spanish)

MEDICAL PROVIDER NETWORK

Below are documents associated with the District's new Medical Provider Network (MPN) effective July 1, 2012.  Please click on the title to view/download/print.

MPN Implementation Notice

MPN Information/Access (English)

MPN Information/Access (Spanish)

MPN DWC7 Poster (English/Spanish)