WebFeb 16, 2024 · The DWC Form-1 and a detailed instruction sheet are available from Risk Management, 505 Broadway, 6th Floor, Redwood City, CA 94063, Ma il Code 6207, phone 650/723-7400. a. Time Limit The DWC Form-1 must be signed by a University representative, and then given or mailed to the employee within 24 hours of the accident, … WebRequest and complete Employee's Claim for Workers' Compensation Benefits (DWC Form 1). Return DWC Form 1 to Supervisor or to Human Resources, Siemen's Hall 212. …
Employer Forms - Workers
WebWorkers' Compensation Claim Form (DWC-1) Download Form. Workplace injuries can happen at any time to anyone. Therefore, it's important to know what to do if you are hurt … WebApplication for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor (Form Number - CM-972; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation) csf life membership
Document Cover Sheet (DWC-CA 10232.1} - Matrix …
WebThe following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs: Form DWC-1 Employer’s First Report of Injury or Occupational Disease. The employer is required to submit this form with EMPLOYERS and the injured employee or the injured employee’s attorney within eight days after the employee’s … WebDWC FORM-1S Instructions PLEASE COMPLETE ALL APPLICABLE FIELDS. Most fields are self-explanatory; however, the following items may require more attention: Item 4: If … WebWorkers' Compensation Claim Form (DWC-1) Download Form Workplace injuries can happen at any time to anyone. Therefore, it's important to know what to do if you are hurt at work. In California, injured workers are entitled to benefits, such as temporary disability, permanent disability and medical treatment. csfl hub all freshman team