Campus Injury Forms

May Be Required for Employees and Students

If you are injured on campus while at work or attending De Anza College, you may be referred to an occupational health clinic for treatment.

In this situation, you may be required to complete certain worker's compensation forms – even if you are a student – and submit them to the Foothill-De Anza district Benefits (Human Resources) office.

Please visit the district's Workers Comp webpage and download the document called "Worker's/Student's Injury Claim Process," which explains the required procedures.

Next, scroll down on the same district webpage to locate and download these three forms:

    • State of California Employer's Report Form (Form 5020)
    • Workers' Comp Report of Injury Form
    • DWC-1 Form

After you download the forms, fill them out and send the completed forms via email to or fax them to 650- 949-6299.

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