Systemwide Risk Management
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Workers' Compensation Forms

The forms referenced on this page are the state required Workers' Compensation forms. Employees should contact their supervisor or campus Workers' Compensation Coordinator to obtain campus-specific forms.

Workers' Compensation New Hire Pamphlet
CSU provides a pamphlet to NEW employees regarding worker's compensation, also referred to as the "Time of Hire Pamphlet". The content for this pamphlet is specified in Labor Code 3551 and Section 9880 of Title 8, California Code of Regulations. The Administrative Director must approve all pamphlets per Regulation 9883.

The Time of Hire Pamphlet shall be given to new employees by the time of their first paycheck.

Workers' Compensation Claim Form
The Workers' Compensation Claim Form, known as the DWC1 form, is given to injured workers within one day of the knowledge of an injury. Current forms may be found at the State of California Division of Workers' Compensation website listed below.

Workers' Compensation Predesignated Personal Physician Forms
The current versions of the forms are the Predesignated Personal Physician and the Notice of Personal Chiropractor or Personal Acupuncturist.

These forms are given to new employees. Current employees may also use these forms to change their election.

RESOURCES

Jacki Graf
Workers' Compensation Consultant
(415) 403-1438

Useful Forms Websites:


Content Contact:
Rebecca Skidmore
(562) 951-4580
Technical Contact:
webmaster@calstate.edu
Last update: January 07, 2016