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California Workers Compensation Forms

<span style="color:red">NEW!</span> SB 1159 --- California Workers' Compensation Reporting Requirement for COVID-19 |  Form Instructions
Form 5020 --- Employer's Report of Occupational Injury or Illness
DWC 1 --- Workers' Compensation Claim Form (English and Spanish)
DWC 7 --- Notice to Employees (English and Spanish)
Time of Hire Pamphlet --- Facts about Workers' Compensation (English)
Time of Hire Pamphlet --- Facts about Workers' Compensation (Spanish)
CL 506-CA --- California Wage Statement

 

 

 
 
 
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Church Mutual Insurance Company, S.I. (a stock insurer)
P.O. Box 357 | 3000 Schuster Lane | Merrill, WI 54452-0357
Telephone (800) 554-2642 or (715) 536-5577

© 2023 Church Mutual Insurance Company, S.I. All rights reserved. Protecting the Greater Good is a registered trademark of Church Mutual Insurance Company, S.I.

Church Mutual is a stock insurer whose policyholders are members of the parent mutual holding company formed on 1/1/20. S.I. = a stock insurer.