Step 1: Report the Injury 

• Immediately notify your supervisor about the injury as soon as it occurs. 

• If your supervisor isn’t readily available, you can contact Giselle Garcia in Human Resources to assist you.  

Step 2: Employee & Supervisor Fill Out DW-1C Form 

• Form: Employee's Claim for Workers' Compensation Benefits - DWC-1 

• Both employee and supervisor have sections to complete with as much detail as possible.  

Step 3: Supervisor Completes 5020 Form 

• Form: Employer's Report Occupational Injury or Illness - 5020 
• Supervisor should provide as much detail as possible. 

Step 4: Submit Forms to Human Resources within 24 Hours 

• The DW-1C and 5020 forms must be submitted to Giselle Garcia within 24 hours of the incident report. 

Step 5: Seek Medical Care 

• Only visit approved medical providers at this link for work-related injuries. 

• Take both forms with you when receiving medical treatment. If you do not have the forms at the time of treatment, inform the provider that the injury is work-related and provide them as soon as possible.  

Step 6: Follow Through and Stay in Communication 

• Attend all recommended medical appointments and follow your treatment plan. 
• Promptly respond to any information requests from Sedgwick, our provider, and Human Resources to ensure timely processing and support.