California Accident or Injury Report

State:
Multi-State
Control #:
US-0022BG
Format:
Word; 
Rich Text
Instant download
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Public form

Description

All accidents are considered as incidents; however an accident report form focuses more on the injury.
An accident report is an important tool used to document the accident and assist in investigating the cause. It also assists to develop procedures that may be put in place to prevent it from happening again.

How to fill out Accident Or Injury Report?

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FAQ

You or your attorney can get a police report after an accident by filling out CHP 190 ? Collision Request Form (PDF) and submitting it along with a photocopy of your state driver's license, ID card, or notarized signature at the nearest California Highway Patrol (CHP) office in person or by mail.

Every physician who treats an injured employee must file a complete Form 5021 Doctor's First Report of Occupational Illness or Injury (DFR) with the employer's claims administrator within five days of the initial examination.

A DWC 1 is the form that is filled out to report an injury to your employer, and officially initiate a workers' compensation claim. DWC stands for Division of Workers' Compensation, this is the government agency that monitors workers' compensation claims and law.

The Cal/OSHA Form 300 is called the Log of Work-Related Injuries and Illnesses, the Cal/OSHA Form 300A is called the Summary of Work-Related Injuries and Illnesses, and the Cal/OSHA Form 301 is called the Injury and Illness Incident Report.

Contact DIR to request an interpreter over the phone: Office NameTopicPhone NumbersCal/OSHAWorkplace Safety and Health833-579-0927Labor Commissioner's OfficeWages, breaks, retaliation and labor laws833-526-4636Division of Workers' CompensationBenefits for work-related injuries and illnesses1-800-736-74011 more row

Accidents and Incidents & Near Misses An accident is an event that has unintentionally happened, that results in damage, injury or harm. An incident is an event that has unintentionally happened, but this may not result in damage, harm or injury.

The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.

California Vehicle Code §20012 states that accident reports are for the confidential use of the California Highway Patrol and the Department of Motor Vehicles. Therefore, car accident reports are not considered public records in California in most circumstances.

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California Accident or Injury Report