Employers Report Of Occupational Injury Or Illness {5020}

FORM 5020 - EMPLOYER’S REPORT OF OCCUPATIONAL INJURY OR ILLNESS. This is a mandatory California form that employers must complete within five days of learning about any workplace injury or illness resulting in lost time beyond the date of the incident or requiring medical treatment beyond first aid. The form captures detailed information about the employer, the injured employee, incident location, cause of injury, medical treatment, hospitalization status, and wage data. It also serves as the employer’s official record for OSHA and workers’ compensation reporting. It includes extensive fields on how the incident occurred, materials involved, and work restrictions, as shown in the image. The form must be completed in triplicate, with two copies mailed to the appropriate workers’ compensation insurance carrier. Filing the form does not constitute an admission of liability. www.FormsWorkflow.com