Use the attached form to file a workers’ compensation claim with your employer. You should read all of the information below. Keep this sheet and all other papers for your records. You may be eligible for some or all of the benefits listed depending on the nature of your claim.

The Division of Workers' Compensation (DWC) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.

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• Provide the employee with Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility form (e3301) within one working day of notice that a work-related injury or illness may have occurred; • Complete an Employer’s Report of …

2016年1月1日 · California law requires employers to provide employees with the DWC-1 form and Notice of Potential Eligibility within one working day of receiving notice or knowledge of a work injury or illness (beyond first-aid.)

2016年12月14日 · An employee uses the Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility (e3301) to formally report a work-related injury or illness to his or her employer and to open a workers' compensation claim file.

If an employee suffers a work-related injury or illness, he or she may be entitled to workers' compensation benefits. Give this form to the employee and have them complete the "Employee" section and then return the form to you.

2024年2月21日 · Form DWC 1 is the official form that California businesses and employees use to file a workers’ compensation claim. The employee fills out a portion of the form, and the employer fills out the remainder.

Formulario de Reclamo de Compensación de Trabajadores (DWC 1) y Notificación de Posible Elegibilidad If you are injured or become ill, either physically or mentally, because of your job, including injuries resulting from a workplace crime, you may be entitled to workers’ compensation benefits. Attached is the form for filing

workers’ compensation benefits. Use the attached form to file a workers’ compensation claim with your employer. You should read all of the information below. Keep this sheet and all other papers for your records. You may be eligible for some or all of the benefits listed depending on the nature of your claim. If you