Workers Compensation Forms

Student Services Building, Room 6381

Monday - Friday 8 a.m. to 5 p.m.

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

Workers' Compensation Forms

Titles

PDF

Word

Excel

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