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ATTACHMENT A COVER PAGE Use this checklist to ensure that all items requested have been included. Items Completed Page (s) 1. Attachment A Cover Page 12. Attachment B Statement of Certification 2
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01
Obtain CA-35PDF form from the US Department website or office.
02
Read the instructions carefully before filling out the form.
03
Fill in the required personal information accurately, such as name, contact information, and employment details.
04
Provide any additional information or supporting documents as requested on the form.
05
Review the completed form for any errors or missing information before submitting.

Who needs ca-35pdf - us department?

01
Employees of the US Department who are required to report certain events or activities as specified by the department.

What is ca-35.pdf - U.S. Department of Labor Form?

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CA-35PDF is a form used by the U.S. Department of Labor to report employee injuries or illnesses that occur in the workplace.
Employers who have employees covered under the workers' compensation program are required to file the CA-35PDF form.
To fill out the CA-35PDF form, provide detailed information about the injured employee, the nature of the injury or illness, the circumstances surrounding the incident, and any medical treatment received.
The purpose of CA-35PDF is to document workplace injuries and illnesses, facilitating the claims process for employees seeking workers' compensation benefits.
The CA-35PDF requires the reporting of employee details, date of injury, description of the injury, treatment provided, and any witnesses to the incident.
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