California Department of Industrial Relations Forms
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DLSE WCA Form 1 "Initial Report or Claim" - California
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DLSE WCA Form 1 "Initial Report or Claim" - California (Chinese)
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55 votes
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DLSE WCA Form 1 "Initial Report or Claim" - California
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7 votes
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DLSE WCA Form 1 "Initial Report or Claim" - California (Korean)
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15 votes
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Form I&A4 "Information & Assistance Unit Guide - How to File an Application for Adjudication of Claim" - California
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17 votes
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5 MB
18 pages
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Form I&A6 "Information & Assistance Unit Guide - How to Request an Expedited Hearing" - California
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23 votes
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4 MB
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Form I&A5 "Information & Assistance Unit Guide - How to File a Declaration of Readiness to Proceed" - California
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29 votes
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3 MB
13 pages
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Form EPA-1 "Equal Pay Act Complaint" - California
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32 votes
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258 KB
3 pages
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Form A-5 "Corporate Resolution Authorizing Application to the Director of Industrial Relations, State of California for a Certificate of Consent to Self-insure Workers' Compensation Liabilities" - California
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39 votes
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Form A-6 "Agreement and Undertaking for Security Deposit" - California
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53 votes
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266 KB
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Form A-4 "Guaranty of Workers' Compensation Liabilities" - California
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41 votes
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332 KB
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Form S-3 "Corporate Resolution Authorizing Application to the Director of Industrial Relations, State of California for a Certificate of Consent to Self-insure Workers' Compensation Liabilities" - California
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71 votes
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508 KB
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Form S-6 "Agreement and Undertaking for Security Deposit" - California
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42 votes
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Form A-1 "Application for Certificate of Consent to Self-insure as a Private Employer Self-insurer" - California
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46 votes
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1 MB
6 pages
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Form A-2 "Application for Certificate of Consent to Self-insure as a Public Agency Employer Self-insurer" - California
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68 votes
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3 MB
5 pages
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Form S-1 "Group Master Application for Certificate of Consent to Self-insure as a Group Self-insurer" - California
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50 votes
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1 MB
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Form S-4 "Indemnity Agreement and Power of Attorney" - California
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68 votes
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Form S-5 "Agreement of Assumption and Guarantee of Workers' Compensation Liabilities for Group and Affiliate Members" - California
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46 votes
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Form I&A1 "Information & Assistance Unit Guide - How to File a Workers' Compensation Claim Form" - California
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5 votes
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6 pages
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Form RCI1 "Retaliation Complaint" - California
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46 votes
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1 MB
8 pages
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Formulario RCI1 "Queja Sobre Represalias" - California (Spanish)
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64 votes
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1 MB
9 pages
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Formulario DLSE-PW1 "Reclamo De Trabajadores De Obras Publicas" - California (Spanish)
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47 votes
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211 KB
2 pages
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Form DLSE-PW1 "Public Works - Worker Complaint" - California
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29 votes
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350 KB
2 pages
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DLSE Form 1 "Initial Report or Claim" - California (Tagalog)
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31 votes
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1 MB
4 pages
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DLSE Form 1 "Initial Report or Claim" - California
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32 votes
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437 KB
4 pages
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Form DLSE8 "Payday Notice" - California
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(4.6 / 5)
20 votes
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54 KB
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Form P-1 "Self-insurer's Profile and Financial Summary Report" - California
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(4.3 / 5)
19 votes
Size:
411 KB
10 pages
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Form J-1 "Joint Powers Authority (Jpa) Self-insurer's Profile and Financial Summary Report" - California
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26 votes
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423 KB
10 pages
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Form I&A19 "Information & Assistance Unit Guide - How to File a Petition Appealing Administrative Director's Independent Medical Review Determination" - California
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33 votes
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4 MB
12 pages
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Form I&A12 "Information & Assistance Unit Guide - How to File a Petition for Reconsideration" - California
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8 votes
Size:
3 MB
12 pages
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Form DAS4A "Division of Apprenticeship Standards Complaint Form" - California
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34 votes
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166 KB
2 pages
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Form A-3A "Private / Public Interim Application" - California
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56 votes
Size:
1 MB
1 page
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Form A-3B "Application for Permanent Certificate of Consent to Self-insure for Interim Self-insurer" - California
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54 votes
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1 MB
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Form S-2B "Application for Affiliate Certificate of Consent to Self-insure as a Member of a Group Self-insurer" - California
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70 votes
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1 MB
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Form S-2A "Group Affiliate Member Interim Application" - California
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44 votes
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1 MB
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WCAB Form 24 "Pre-trial Conference Statement" - California
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(4.6 / 5)
30 votes
Size:
4 MB
5 pages
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Form 33 "Safety and Health Program Assessment Worksheet" - California
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80 votes
Size:
52 KB
11 pages
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DWC/WCAB Form 37 "Notice of Dismissal of Attorney" - California
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25 votes
Size:
122 KB
1 page
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Form DWC-AU-906 "Audit Complaint Form" - California
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44 votes
Size:
87 KB
1 page
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Form OSHAB-316 "Subpoena Re Deposition" - California
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22 votes
Size:
297 KB
4 pages
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