Process for Reporting Worksite Injuries

Since SASSFA will be processing participant payroll, we will also be responsible for the Youth Employment Program Worker's Compensation Insurance coverage.

In case of a worksite injury, the worksite supervisor will follow these procedures:

Serious Injuries (head, eye wounds, broken bones, neck injuries, etc.)

  • The worksite supervisor shall immediately call 911 and report the injury, giving the dispatcher as much detail as possible. (i.e., nature of injury, how it occurred, location, address, etc.) Soon thereafter, the worksite supervisor shall report the injury to the YEP Program Coordinator and Alma Rosa Martinez. IMPORTANT: The Accident - Incident Report (SASSFA Form 017-2-97) is to be filled out and faxed to SASSFA at (562) 948-5818.

Average Injuries (sprains, contusions, back pain, etc.)

  • The worksite supervisor shall immediately call the Youth Employment Program Coordinator. In addition, s/he will complete SASSFA form 017-2-97 and call Ms. Alma Rosa Martinez.
  • After making the appropriate calls, the worksite supervisor shall arrange to have the participant transported to SASSFA's authorized treatment center.
  • The worksite supervisor shall complete the Authorization to Treat form and send the participant with the original of the form to:
    Health First Medical Group - North
    11817 E. Telegraph Road
    Santa Fe Springs, CA 90670
    (562) 949-9328

    The treatment center shall provide treatment and either release the participant or recommend further treatment.

Minor Injuries (small cuts, etc.)

  • The worksite supervisor shall treat the wound using their first aid kit and report the injury to the Contractor's program coordinator. In addition, s/he will complete SASSFA forms 017-2-97 Accident-Incident Report, and mail the original to Partners for Progress after calling Ms. Alma Rosa Martinez, at (562) 946-2237, extension 222 and reporting the injury.


100% Services Funded by the Los Angeles County Workforce Development Board with funds from the Workforce Innovation and Opportunity Act (WIOA). Workforce Development Aging and Community Services (WDACS) and the Los Angeles County America's Job Centers of California are equal opportunity employers/programs. Auxiliary aids and services are available upon request, to individuals with disabilities. TTY (562) 236-2899.