WebForms Georgia State Board of Workers’ Compensation provides all forms, upon request, free of charge. To request copies of forms, please call (404) 656-3870. Do not send any additional copies of any forms when filing in paper. STAMPED COPIES WILL NOT BE RETURNED. A Stipulated Settlement is the only exception to this rule. WebIf unable to scan in color, send original documents to Human Resources/Workers’ Compensation. ATTACHMENTS 1. Report of Occupational Injury or Illness (CA Form 5020) 2. Employee’s Claim for Workers’ Compensation Benefits (CA Form DWC-1) 3. Body Diagram 4. Supervisor’s Incident Investigation Report 5.
California Workers’ Comp Forms & Resources
WebEmployers do not need to file a DWC-1 Claim Form or an Employers' Report of Occupational Injury or Illness (Form 5020) for injuries that result in first aid treatment … WebFORM 5020 (Rev7) June 2002 FILING OF THIS FORM IS NOT AN ADMISSION OF LIABILITY OSHA CASE NO. FATALITY 1. FIRM NAME Ia. Policy Number 2. MAILING … highlands regional hospital sebring
Printable 2024 District of Columbia Form D-2220 (Underpayment …
WebATTENTION This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the … Web18. Date employee was provided Workers’ Compensation Claim Form (DWC 1) -Enter the date the form was given or mailed to the employee. 19. Specific injury or illness and medical diagnosis - Indicate the nature of the injury/ illness. 19a. Body Part Affected - Use the exact part(s) of body injured. Include left or right, upper or lower, etc. 20. http://cal-osha.ca.gov/dwc/forms/5021.pdf how is mycoprotein made