EMPLOYMENT SERVICES

BENEFITS

CUSTOMER SERVICE

INFORMATION

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Cal Poly Pomona Foundation, Inc.

Safety & Workers Compensation

Forms

This is a list of Safety and W/C Forms
Date	Description
1/1/2022	1. Employee's Claim for Injury While at Work- DWC1
1/1/2022	2. Employer's Report of Occupational Injury or Illness-5020 Form1
1/1/2022	3. Report of Employee Injury or Illness
1/1/2022	4. Declination of Workers' Compensation Benefits (Medical Treatment)
1/1/2022	5.Treatment Authorization Form
1/1/2022	Presence of Asbestos Memorandum
1/1/2022	Report of Employee Incidents, First Aid, Minor Accidents
1/1/2022	Safety Orientation Checklist
1/1/2022	Supervisor's Guide to Report Workplace Injuries
1/1/2022	Workers Compensation Information

About the Foundation

The Cal Poly Pomona Foundation, Inc., established in 1966, is an integral component of the educational mission of the University.

The Foundation exists to enhance the university and community experience through optimized solutions and resource generation that empower student success. [ Read More About The Foundation's Commitment ]

Investing In Ourselves

Your continued loyalty to Cal Poly Pomona Foundation, Inc., (Bronco Bookstore, Dining Services, University Village, Kellogg West, and the Farm Store) makes many scholarships, campus programs and activities a reality.

Cal Poly Pomona Foundation, Inc.is a non profit organization, serving Cal Poly Pomona for over 50 years. The Foundation employs over 1,000 Cal Poly Pomona students each year [Read More About The Foundation's Investing In Ourselves ]

Cal Poly Pomona Foundation, Inc

3801 W. Temple Ave.,
Building 55
Pomona, CA 91768

909-869-2950 Voice
909-869-4549 Fax

Office Hours (Building 55):
M-F: 8 a.m. – 5 p.m.

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