Form 5020 Employer’s Initial Report of Injury

Last UpdatedOctober 26, 2016
Total Files2
VersionRev 7 June 2002

Employers are required to report to workers' compensation 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. For more information on reporting, download the form or visit the CA DIR's Division of Workers' Compensation website linked below.

Download & Links
Form 5020
Link to CA Dept. of Industrial Relations - Division of Workers' Compensation (DWC) Forms directory
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