Form CCA-0005A Log of Accidents, Injuries or Illnesses - Arizona (English / Spanish)

What Is Form CCA-0005A?

This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form CCA-0005A?
A: Form CCA-0005A is a Log of Accidents, Injuries or Illnesses in Arizona.

Q: What is the purpose of Form CCA-0005A?
A: The purpose of Form CCA-0005A is to record and track accidents, injuries, or illnesses that occur in the workplace.

Q: Who needs to use Form CCA-0005A?
A: Employers in Arizona are required to use Form CCA-0005A to document workplace accidents, injuries, or illnesses.

Q: Is Form CCA-0005A available in multiple languages?
A: Yes, Form CCA-0005A is available in both English and Spanish.

Q: Do I need to submit Form CCA-0005A to any specific agency?
A: In Arizona, Form CCA-0005A is not required to be submitted to any specific agency. However, it should be kept on file for inspection purposes.

Q: What information should be included in Form CCA-0005A?
A: Form CCA-0005A should include details such as the date, time, location, description of the accident, injury, or illness, as well as any medical treatment provided.

Q: How long should Form CCA-0005A be kept on file?
A: Form CCA-0005A should be kept on file for a minimum of five years.

Q: Is Form CCA-0005A mandatory for all types of workplaces?
A: Yes, all types of workplaces in Arizona are required to maintain Form CCA-0005A, regardless of industry or size.