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Below are copies of State Mandated forms from the Department of Industrial Relations for your use. We have also included links to various government agencies, related organizations and consulting companies.

Forms

click to download

  • WORKERS’ COMPENSATION CLAIM FORM (DWC 1)
  • Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility
  • DWC – AD 10118 – NOTICE OF OFFER OF REGULAR WORK
  • FORM 5020 – EMPLOYER’S REPORT OF OCCUPATIONAL INJURY OR ILLNESS
  • Cal/OSHA Form 300A – Annual Summary of Work-Related Injuries and Illnesses
  • Cal/OSHA Form 300 – Log of Work-Related Injuries and Illnesses
  • Cal/OSHA Form 301 – Injury and Illness Incident Report
  • Cal/OSHA – Forms for Recording Work-Related Injuries and Illnesses
  • Time Of Hire Pamphlet
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Department of Industrial Relations
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PARMA
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DMEC
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COSIPA

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