Get Form 5020

Filling out the Form 5020 online is a crucial step for employers reporting occupational injuries or illnesses in California. This guide will assist you in completing the form accurately to ensure compliance with California law.

Follow the steps to successfully complete the Form 5020 online.

1. Click ‘Get Form’ button to access the online form and open it in your preferred editor.
2. Begin by entering your firm name in the designated field. Ensure that the name reflects the official name of your business.
3. Provide the policy number in the appropriate section, following the instructions explicitly.
4. If the location is different from the mailing address, complete the separate location field with the designated information.
5. Indicate the nature of your business in detail (e.g., painting contractor, hotel) to provide context regarding the operations.
6. Select the type of employer: private, county, state, school district, or other government, as applicable to your organization.
7. Record the date of the injury or onset of illness using the format mm/dd/yy to ensure clarity.
8. Enter the time when the injury or illness occurred. Use AM or PM to specify the correct timeframe.
9. If the employee passed away due to the injury, document the date of death, if known.
10. Answer the question regarding whether the employee was unable to work for at least one full day after the incident.
11. Indicate the phone number where you can be reached for follow-up or clarification.
12. Provide additional details such as occupation, salary status, and specifics of the injury or illness sustained.
13. Thoroughly describe how the injury/illness occurred, including the sequence of events that led to it.
14. Once all fields are completed, review the information for accuracy before saving changes.
15. Download or print the completed Form 5020, and send the required copies as instructed.

Take action now and complete the Form 5020 online to ensure timely reporting of occupational injuries or illnesses.