Due Date: First Day of Class

While working in the hospital and on the ambulance as part of this course you are covered by COC's Worker's Compensation Program. That means if you get hurt during a clinical shift, COC will send you to a Worker's Compensation doctor and treat you for free, and cover your bills if you are treated in an emergency room. You can choose to be treated by your own doctor at your expense instead, but they must agree to it in advance by signing page 2 of the Designated Physician form. This must be done by Week 1 of the course.

Step 1
- DO NOT PRINT this packet! ONLY PRINT the forms below in Step 2.
- Read the Worker's Compensation Packet very carefully. It explains what to do if you get hurt while off-campus for clinical shifts, and what will happen afterwards.
Step 2
Use a computer, not a phone or tablet
- Students can access computers for free at the Valencia TLC and Library and the Canyon Country Library and Learning Center in the Student Services Building.
- Students who have paid the Student Support Fee can print documents for free (worth up to $16/month ) through the Wepa app.
Download and save the PRIME Advantage MPN Complete Written Employee Notification – Employee Acknowledgment
Open the saved file
Type in your information
- Signature: May be digital, or you can hand sign after you print
- Date: Use the dropdown to select today's date
Print the form (and sign if you didn't do it digitally)
Use a paperclip to attach it to Checklist 1 in the order shown on the checklist

Due Date: First Day of Class

Step 1

Step 2