Workers' Compensation Claim Form

Form #:CA-WC-0001
This form is used by an employee who has been injured on the job to report the injury to their employer. The form covers the nature and extent of the injury and information about the employee. Once the employer receives the form from the injured employee, they should add to the form information about when they first learned of the injury and when they received the form. The completed form should then be sent to their insurer or claims administrator, as well as returned to the employee.

Name:Workers' Compensation Claim Form
Form Number: CA-WC-0001
State:California
Statute:
Form Category:Workers' Compensation

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