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Employer Resource Library

California Employer Resource Guide

Cover Sheet and Welcome Letter

Table of Contents

Instructions for Posters

DWC-7 – Notice to Employees – Injuries Caused by Work (Español)

Fraud Prevention Poster (Español)

Instructions for Injury Report Forms

DLSR-5020 – Employer’s Report of Occupational Injury or Illness

DIA-510 – Notice of Employee Death

Incident Investigation Report (Español)

Supervisor’s Report of Employee Incident (Español)

Witness Statement of Injury or Incident (Español)

Instructions for Injured Worker Handouts

DWC-1 – Claim Form & Notice of Potential Eligibility (Español)

Employee Medical Provider Network Notice (Español)

Notice to Victims of Workplace Crimes (Español)

Employee Acknowledgement Form (Español)

Consent & Authorization for Release of Information Form (Español)

Request for Medical History Form (Español)

Instructions for Informational Documents

Omaha National Contact Information

Medical Provider Network (MPN) Information for Employers

Reduce Your Workers Compensation Costs

Instructions for General Forms

Request for Subrogation Waiver

Notice of Ownership Change

Company Contacts Verification

Instructions for State-Specific Forms & Documents

DWC Time of Hire Pamphlet (Español)

Employee Acknowledgement Form (Español)

Omaha National Group

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