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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 workers compensation forms and

01
Obtain the workers compensation forms from your employer or the workers compensation board.
02
Fill out personal information such as name, address, contact details, and social security number.
03
Provide details about the injury or illness that occurred at the workplace, including date, time, and location.
04
Describe the nature of the injury or illness and the body parts affected.
05
Include information about the medical treatment received and any healthcare providers visited.
06
Sign and date the form before submitting it to the appropriate authority.

Who needs workers compensation forms and?

01
Employees who have suffered an injury or illness while performing their job duties.
02
Employers who are required to report workplace injuries and illnesses to the workers compensation board.
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Workers compensation forms are documents that employees can use to file a claim for compensation if they are injured or become ill as a result of their work.
Employers are required to file workers compensation forms for their employees who have been injured or become ill on the job.
Workers can fill out workers compensation forms by providing information about their injury or illness, including how it occurred and what medical treatment they have received.
The purpose of workers compensation forms is to provide a mechanism for employees to seek compensation for injuries or illnesses sustained on the job.
Workers must report information such as the date and time of the injury or illness, how it occurred, and any medical treatment received.
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