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PRINT. State of California Department of Industrial Relations DIVISION OF WORKERS COMPENSATION CLAIM FORM (DWC 1) Employee: Complete the Employee section and give the form to your employer. Keep a

How to fill out dwc-1 and nope

How to Fill out DWC-1 and NOPE:

1. Obtain the necessary forms: To begin filling out the DWC-1 form, you can obtain a copy from your employer or workers' compensation insurance provider. NOPE (Notice of Personal Injury or Occupational Disease Exposure) is typically provided by your employer or insurance company as well.
2. Fill in personal information: Start by providing your full name, address, and contact details in the specified sections of both forms. It is important to ensure that this information is accurately filled out.
3. Provide employer details: In both forms, you need to provide information about your employer, such as the company name, address, and contact information. This helps identify the employer involved in the reported incident.
4. Describe the incident: Both the DWC-1 and NOPE forms require a detailed description of the incident, injury, or exposure that occurred. Use clear and concise language to provide a factual account of what took place. Include relevant information such as the date, time, and location of the incident.
5. Indicate the nature of the injury or illness: In the DWC-1 form, you will be asked to describe the nature of your injury or illness. Specify the body parts affected and the extent of the injury. In the NOPE form, you may need to provide details regarding the occupational disease or exposure.
6. Witness information: If there were any witnesses to the incident, provide their names, contact information, and brief statements about what they observed. This can be included in both the DWC-1 and NOPE forms, if applicable.
7. Seek medical treatment: It is crucial to seek medical attention for your injury or illness. The DWC-1 form asks for information about the treating physician, so make sure to include their name and contact details. In the NOPE form, you may need to provide information about the medical facility where you received treatment.
8. Signing and submitting the forms: After completing the forms, carefully review all the information provided. Sign and date both the DWC-1 and NOPE forms. Keep a copy for your records and submit the originals to your employer or workers' compensation insurance provider as per their instructions.

Who needs DWC-1 and NOPE?

Both the DWC-1 and NOPE forms are necessary for employees who have sustained a work-related injury, illness, or occupational exposure. If you experience an injury or illness while on the job, these forms help initiate the workers' compensation claim process and ensure that your employer and insurance provider are informed of the incident. It is essential for all employees who are seeking medical treatment or compensation for work-related injuries or illnesses to complete and submit these forms accurately and in a timely manner.

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