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PO Box 490, Santa Maria, CA 93456 Phone: (805) 348-3333 x1 Fax: (805) 456-6410

Risk Management

Risk Management Contact
Michele Duston
805-348-3333 ext 1020
***Certificate of Insurance***
 
A Certificate of Insurance for an event taking place at a non-school location.  To request a certificate of insurance please email [email protected] with a copy of the contract or MOU.

***Employee Accident/Injury*** 

Notice to Employees
Workers Compensation
 
Employer Name: Family Partnership Home Study
The above-named employer, an employer within the meaning of the Worker's Compensation Law of the State of California hereby gives notice to employees that the em[ployer has secured the payment of compensation to its employees in accordance with the provisions of said law, by insuring with:       
                                                        Insurance Company: EMPLOYERS PREFERRED INS.
                                                                          Policy effective Dates: 7-1-22 to 7-1-23
                                                                          Policy Numer: EIG 4797654 01
 
 

EMPLOYERS® offers two convenient phone numbers that are available 24/7 to report a
claim with less paperwork.* Both numbers are staffed with individuals fluent in both
English and Spanish, with accommodations for other languages.
             1. Injured Employee Hotline – 855-365-6010
                  • Reporting of a new work-related injury or illness when the injured/ill employee
                     has not yet received medical treatment.
                     ------Access to registered nurses who are specially trained to provide nurse triage
                             and medical guidance.
             2. Customer Support – 888-682-6671
                 • Reporting of a new work-related injury or illness when the injured/ill employee
                   has already received medical treatment.
                   ____Injured employees who have not yet sought medical treatment will be
                            transferred to our Injured Employee Hotline (IEH) and provided the IEH phone
                             number.
*For all injuries or illnesses that require immediate assistance from Emergency Services
please call 911. 

 

If you are hurt at work, it is imperative that you or your Supervisor/Manager report your work-related injury or illness, regardless of nature or severity, to [email protected] immediately

 

All non-work-related injuries/illnesses that have an impact on an employee’s ability to do the essential functions of the job must be reported to [email protected]

For more information regarding claims click the link below:

https://www.employers.com/claims-services/

The accident investigative report form should be completed by the employee’s supervisor/manager as soon as possible after the accident. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should also keep a copy on file for your records.
 
CA-DWC7-claim-form is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within one working day from you becoming aware of a work-related injury or occupational disease. Please provide a copy to your employee and keep a copy for your records.

***Student Accident/Incident Report*** 

Coordinators, Teachers, IA's, and Clerical:

When a student gets injured please fill out below Student Accident- Incident Report.  Student Accident- Incident Report must be completed by the FP Charter employee in charge of the injured student immediately or by the end of that school day. Filled out form must be printed before submitting and emailed to the Director of Risk Management. This information is confidential and privileged and should not be provided to a parent or other person.

If an accident or incident occurs involving a non-student or non-employee such as a visitor or parent, the same form must be completed. 

Volunteer Handbook and Application 
 
 
VOLUNTEERS LIVE SCAN
SCHOOL FIELD TRIP PROPOSAL'S/FIELD TRIP POLICY AND FORMS