5020 Employer's Report of occupational Injury or Illness
NOTICE: California law requires employers to report within five days of knowledge every occupational injury or illness which results in lost time beyond the date of the incident OR requires medical treatment beyond first aid. If an employee subsequently dies as a result of a previously reported injury or illness, the employer must file within five days of knowledge an amended report indicating death. In addition, every serious injury/illness, or death must be reported immediately by telelphone or telegraph to the nearest office of the California Division of Occupational Safety and Health.
This form must be typed. You may download either:
Risk Management, Mail Code: 6207, 723-7400