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Forms

Employee/Volunteer Injury/Illness Report [PDF]
Supervisor Injury/Illness Report [PDF]
Witness Report of Injury/Illness [PDF]
Notice of Personal Chiropractor or Personal Acupuncturist [PDF]
Physician Pre-Designation
Workers' Compensation Claim Form (DWC1) & Notice of Potential Eligibility [PDF]

Submitting Forms & Documents

Please submit Workers' Compensation form(s) and supporting documents to our Workers' Compensation Secure Dropbox or deliver to WH 340.

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1000 E. Victoria Street
Carson, CA 90747
310-243-3696

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