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PRINTCLEARSTATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS Division of Workers\' Compensation Notice to EmployeesInjuries Caused By Work You may be entitled to workers\' compensation benefits
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How to fill out division of workers compensation

01
Gather all necessary information such as employee name, address, social security number, and job title.
02
Fill out details about the injury including the date it occurred and a description of how it happened.
03
Provide information about the medical treatment received by the employee for the injury.
04
Include information about any lost wages or time off work due to the injury.
05
Sign and date the division of workers compensation form before submitting it.

Who needs division of workers compensation?

01
Employees who have suffered a work-related injury and are seeking compensation.
02
Employers who are required by law to report and document workplace injuries.
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Division of workers compensation is a form used to report work-related injuries or illnesses and to determine benefits for employees.
Employers are required to file division of workers compensation when an employee is injured or becomes ill due to work-related activities.
Division of workers compensation can be filled out by providing details of the injury or illness, including the date, time, and location it occurred, as well as information about the employee and their medical treatment.
The purpose of division of workers compensation is to ensure that employees receive proper medical care and compensation for work-related injuries or illnesses.
Information that must be reported on division of workers compensation includes details of the injury or illness, the date and time it occurred, the employee's personal information, and information about the medical treatment received.
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