Workers Compensation Forms

Administration Building, Room 601

Hours: Monday - Friday from 8 a.m. to 5 p.m.

Phone (323) 343-3657 | Fax (323) 343-3662

Workers' Compensation Forms

Titles

PDF

Word

Employee's Report of Occupational Injury or Illness

Employee's Report of Occupational Injury or Illness-PDF  

Supervisor's Report of Occupational Injury or Illness

Supervisor's Report of Occupational Injury or Illness-PDF  

Workers' Compensation Personal Physician Designation

Workers' Compensation Personal Physician Designation-PDF Workers' Compensation Personal Physician Designation-DOC

Workers' Compensation Claim Form (DWC 1)

Workers' Compensation Claim Form (DWC 1)-PDF