HR Forms and Checklists

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Free Forms

  • Application for Permission to Work - Entertainment Industry - DLSE277

    Free

    Use this Division of Labor Standards Enforcement (DLSE) application when employing minors to work in the entertainment industry. This form is not a permit.

    Preview  |  Download

  • Application for Permission to Work - Entertainment Industry - DLSE277 - Spanish

    Free

    Use this Division of Labor Standards Enforcement (DLSE) application when employing minors to work in the entertainment industry. This form is not a permit.

    Preview  |  Download

  • Application to Employ Minors - Entertainment Industry - DLSE281

    Free

    Use this form if you are planning to hire a minor to work in the entertainment industry. This form is required by law.

    Preview  |  Download

  • Application to Employ Minors - Entertainment Industry - DLSE281 - Spanish

    Free

    Use this form if you are planning to hire a minor to work in the entertainment industry. This form is required by law.

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  • California Paid Sick Leave: Frequently Asked Questions

    Free

    This guidance document was created by the California Department of Industrial Relations to answer questions that are frequently asked about California’s mandatory paid sick leave law. It does not address every possible situation.​​​

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  • CalOSHA Forms 300 300A and 301

    Free

    A CalOSHA-created spreadsheet containing all three required forms to report workplace injuries.

    Preview  |  Download

  • CHIP-Childrens Health Insurance Program-Model Notice for Employers

    Free

    If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.  ​​​​​

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  • CHIP-Childrens Health Insurance Program-Model Notice for Employers - Spanish

    Free

    If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.  ​​​​

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  • CHIPRA Fact Sheet

    Free

    The DOL has posted a model employer Children's Health Insurance Program (CHIP) Notice that can be used to satisfy the employer notice requirement under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). CHIPRA added new notice and disclosure obligations for employers that provide group health plans in states that offer Medicaid or state CHIP assistance in the form of premium assistance subsidies.  CHIPRA also created additional HIPAA special enrollment rights that permit eligible employees and their dependents to enroll in an employer's group health plan in two situations: (1) when Medicaid or CHIP coverage is terminated due to loss of eligibility; and (2) upon eligibility for a premium assistance subsidy under Medicaid or CHIP. The Employer CHIP Notice must be provided annually, on an automatic basis and free of charge. It must inform each employee (regardless of enrollment status) of potential opportunities for premium assistance in the state in which the employee resides. ​

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  • Comparison of California State and Local Paid Sick Leave Laws

    Free

    Use this chart to compare California paid sick leave requirements to various local paid sick leave requirements. This chart was prepared by Fox Rothschild LLP​​​​.​​​​

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  • DE4 - California Employees Withholding Certificate

    Free  |  Updated

    Copy and distribute this form from the EDD to employees to determine his/her withholding allowance.​​

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  • Employment Determination Guide - Form DE38

    Free

    Use this worksheet to determine whether a worker is most likely an employee or an independent contractor.​

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  • Fair Credit Reporting Act - Summary of Your Rights

    Free

    Provide a copy of this summary to the consumer (employee or applicant) before taking adverse action based on the results of a credit report. A copy of the report must accompany the summary.​​

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  • Fair Credit Reporting Act - Summary of Your Rights - Spanish

    Free

    ​Provide a copy of this summary to the consumer (employee or applicant) before taking adverse action based on the results of a credit report. A copy of the report must accompany the summary.​​

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  • Family Care and Medical Leave (CFRA Leave) and Pregnancy Disability Leave Notice - 50 or More Employees

    Free

    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition and/or who is seeking family care or medical leave. This notice applies to California employers with 50 or more employees (subject to the CFRA or FMLA). You must post this notice in a place commonly used by employees, such as a break room. Employers are also encouraged to give this notice at time of hire to each new employee. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.​​

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  • Family Care and Medical Leave (CFRA Leave) and Pregnancy Disability Leave Notice - 50 or More Employees - Spanish

    Free

    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition and/or who is seeking family care or medical leave. This notice applies to California employers with 50 or more employees (subject to the CFRA or FMLA). You must post this notice in a place commonly used by employees, such as a break room. Employers are also encouraged to give this notice at time of hire to each new employee. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.​

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  • Federal Minimum Wage Poster - Black and White

    Free

    Every employer of employees subject to the Fair Labor Standards Act's minimum wage provisions must post, and keep posted, a notice explaining the Act in a conspicuous place in all of their establishments so as to permit employees to readily read it. ​​

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  • Federal Minimum Wage Poster - Color

    Free

    Every employer of employees subject to the Fair Labor Standards Act's minimum wage provisions must post, and keep posted, a notice explaining the Act in a conspicuous place in all of their establishments so as to permit employees to readily read it.​

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  • Federal Minimum Wage Poster - Spanish - Black and White

    Free

    Every employer of employees subject to the Fair Labor Standards Act's minimum wage provisions must post, and keep posted, a notice explaining the Act in a conspicuous place in all of their establishments so as to permit employees to readily read it. Spanish version.​​

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  • Federal Minimum Wage Poster - Spanish - Color

    Free

    Every employer of employees subject to the Fair Labor Standards Act's minimum wage provisions must post, and keep posted, a notice explaining the Act in a conspicuous place in all of their establishments so as to permit employees to readily read it. Spanish version.​​​

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  • H-2A Program Employee Rights

    Free

     Required H-2A poster for employers with agricultural (H-2A) workers.

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  • H-2A Program Employee Rights - Spanish

    Free

     Required H-2A poster for employers with agricultural (H-2A) workers.  

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  • Heat Illness Prevention Regulation Amendments Guidance

    Free

    This chart was created by Cal/OSHA to address 2015 changes to Cal/OSHA heat illness prevention regulations. It is intended to provide guidance on how to implement the new requirements; it does not address every possible situation.
    ​​

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  • Human Trafficking Model Notice

    Free

    Certain businesses must post this model notice providing information relating to how to report suspected human trafficking and access to help and services. For information on who must post this notice, see Facts on Human Trafficking Posting.​

    The notice to be posted must be at least 8.5 x 11 inches and size 16 font.

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  • Human Trafficking Model Notice - Spanish

    Free

    Certain businesses must post this model notice providing information relating to how to report suspected human trafficking and access to help and services. For information on who must post this notice, see Facts on Human Trafficking Posting.

    The notice to be posted must be at least 8.5 x 11 inches and size 16 font.

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  • I-9 - Employment Eligibility Verification

    Free

    Use this required form for every employee to verify legal employment eligibility. Starting 01/22/17, USCIS will only accept the 11/14/16 edition of this form. You can find the edition date at the bottom of the page on the form. Use these I-9 - Employment Eligibility Verification - Instructions​ or I-9 - Employment Eligibility Verification - Instructions - Spanish​​ to assist you in properly completing the ​Form I-9.​​


    How to Download
    We suggest you download the PDF directly to your local computer. You should use the latest version of the free Adobe Reader. The Internet Explorer, Firefox and Safari web browsers will prompt you to open or save the form. To download the form from the Chrome web browser:​​
    1. Click the link to the Form I-9 you wish to download.
    2. Click the arrow that displays in the PDF file download box that will appear in the bottom left-hand corner.
    3. Select “Show in folder” from the drop-down that appears.
    4. ​Open the form that appears in your Download folder.
    For best results, ​use the most current version of the browser of your choice.​

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  • I-9 - Employment Eligibility Verification - Instructions

    Free

    ​Both employers and employees are responsible for completing their respective sections of Form I-9 to verify legal employment eligibility. ​Use these USCIS instructions to assist you in properly completing the Form I-9.​

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  • I-9 - Employment Eligibility Verification - Instructions - Spanish

    Free

    ​Both employers and employees are responsible for completing their respective sections of Form I-9 to verify legal employment eligibility. ​Use these USCIS instructions to assist you in properly completing the Form I-9.​​

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  • I-9 - Employment Eligibility Verification - Spanish

    Free

    The Spanish version of Form I-9 may be filled out by employers and employees in Puerto Rico ONLY. Spanish-speaking employers and employees in the 50 states and other U.S. territories may print this for their reference but may only complete the form in English to meet employment eligibility verification requirements.

    Starting 01/22/17, USCIS will only accept the 11/14/16 edition of this form. You can find the edition date at the bottom of the page on the form. See the I-9 - Employment Eligibility Verification - Instructions​ or I-9 - Employment Eligibility Verification - Instructions - Spanish​ ​to assist you in properly completing the Form I-9​.​

    Instructions​​​​​​​​​​​​​​​

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  • Independent Contractors Report - DE542

    Free

    Any business or government entity that is required to file a Federal Form 1099-MISC for service performed by an independent contractor must report using this form. You must report to the Employment Development Department within twenty (20) days of EITHER making payments of $600 or more OR entering into a contract for $600 or more with an independent contractor in any calendar year, whichever is earlier. This information is used to assist state and county agencies in locating parents who are delinquent in their child support obligations. ​​

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  • Injury and Illness Incident Report - Form 301

    Free

    Along with an accompanying Summary, you must fill out this form or an equivalent within 7 calendar days after you receive information that a recordable work-related injury or illness has occurred. Some state workers’ compensation, insurance, or other reports may be acceptable substitutes if the forms contain all the information asked for on this form. You must keep this form on file for 5 years following the year to which it pertains.​

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  • Los Angeles Fair Chance Initiative - Notice to Rescind Employment Offer - Sample Letter

    New  |  Free

    ​For use by employers located or doing business in the City of Los Angeles and employing 10 or more employees. Use this sample letter to provide notice to a job applicant that you are considering rescinding a job offer. This letter provides the applicant with an opportunity to provide additional information for the employer t​o consider. This sample letter is provided by the Los Angeles City ​Bureau of Contract Administration.

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  • Medical Provider Network - Notice of Plan Modification

    Free

    Submit an original Notice of MPN Plan Modification with original signature, any necessary documentation, and a copy of the Notice and documents to the Division of Workers' Compensation.​

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  • Minimum Wage Order

    Free

    Post this official California Minimum Wage notice next to the IWC Wage order for your industry.

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  • Minimum Wage Order - Spanish

    Free

    Post this official California Minimum Wage notice next to the IWC Wage order for your industry.

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  • Minors - Statement of Intent to Employ and Request for Work Permit - Form B1-1

    Free

    Use this form when employing minors who are required to attend school and file it with the school district for each minor. You can obtain this form by contacting the Office of the Superintendent of the minor's school district. The form should be completed by the minor and signed by the employer.​​

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  • New Employees Print Specifications Report - Form DE34

    Free

    If you create your own format to report new hires to the state rather than using the official DE34 form, this information sheet contains the necessary data to insure that your format complies with the state's requirements.

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  • New Employees Report - Form DE34

    Free

    Federal law requires all employers to report to EDD within 20 days of start of work all employees who are newly hired or rehired. This information is used to assist state and county agencies in locating parents who are delinquent in their child support obligations. An individual is considered a new hire on the first day in which he/she performs services for wages. In addition, any employee who is rehired after a separation of at least sixty (60) consecutive days must also be reported within the 20 days.​

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  • New Health Insurance Marketplace Coverage Options and Your Health Coverage - for Employers That Do Not Offer a Health Plan

    Free  |  Updated

    Under the Affordable Care Act, employers must provide a notice of coverage options to employees. The U.S. Department of Labor has provided this model notice for use by employers who do not offer a health plan. ​

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  • New Health Insurance Marketplace Coverage Options and Your Health Coverage - for Employers That Offer a Health Plan

    Free  |  Updated

    Under the Affordable Care Act, employers must provide a notice of coverage options to employees. The U.S. Department of Labor has provided this model notice for use by employers who offer a health plan to some or all employees. ​

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  • New Health Insurance Marketplace Coverage Options and Your Health Coverage (for Employers That Do Not Offer a Health Plan) - Spanish

    Free  |  Updated

    Under the Affordable Care Act, employers must provide a notice of coverage options to employees. The U.S. Department of Labor has provided this model notice for use by employers who do not offer a health plan. ​​

    Preview  |  Download

  • New Health Insurance Marketplace Coverage Options and Your Health Coverage (for Employers That Offer a Health Plan) - Spanish

    Free  |  Updated

    Under the Affordable Care Act, employers must provide a notice of coverage options to employees. The U.S. Department of Labor has provided this model notice for use by employers who offer a health plan to some or all employees.  ​

    Preview  |  Download

  • NLRB Form 4767 - Notice of Appeal

    Free

    Use this form to appeal to the General Counsel of the National Labor Relations Board from the action of the Regional Director in refusing to issue a complaint on an NLRB charge.

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  • NLRB Form 601 - Withdrawal Request

    Free

    File this form with the NLRB to request a withdrawal of a petition or charge pending before the NLRB. 

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  • Notice of Offer of Modified or Alternative Work for Injuries Occurring Between 1-1-04 and 12-31-12 (DWC-AD 10133.53)

    Free

    Use this form in making a return-to-work offer. This form is to be used for injuries occurring between 1/1/04 and 12/31/12. ​

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  • Notice of Offer of Regular Modified or Alternative Work For Injuries Occurring on or after 1-1-13 (DWC-AD 10133.35)

    Free

    Use this form in making a return-to-work offer. This form is to be used for injuries occurring on or after 1/1/13.

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  • Optional Worksheet to Help You Fill Out the Annual Summary - Form 300A

    Free

    Use this worksheet to gather the data needed to prepare the Summary of Work-related Injuries and Illnesses (Form 300A).

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  • Permit to Employ and Work - Form B1-4

    Free

    This is a sample of the permit you must have on file for each minor you employ. You can obtain this permit by contacting the Office of the Superintendent of the minor’s school district.

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  • Pregnancy Disability Leave Notice

    Free

    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition. This notice applies to California employers with 5 or more employees. You must post this notice in a place commonly used by employees, such as a break room. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.​​

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  • Pregnancy Disability Leave Notice - Spanish

    Free

    This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition. This notice applies to California employers with 5 or more employees. You must post this notice in a place commonly used by employees, such as a break room. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.​

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  • Pregnancy Discrimination Brochure

    Free

    Copy and distribute this sample copy of California's Department of Fair Employment and Housing (DFEH) informational brochure to employees along with the required PDL notice. There is no legal requirement to distribute these brochures.

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  • San Francisco Flexible or Predictable Work Arrangement Request

    Free

    Employees covered by the San Francisco Family Friendly Workplace Ordinance may (but are not required to) use this sample form to request flexible or predictable working arrangements from their employers.

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  • State Disability Insurance and Paid Family Leave Benefit Amounts

    Free

    Use this table to determine what benefits an employee is eligible for under State Disability Insurance and Paid Family Leave. For more information, go to www.edd.ca.gov.​​​

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  • Texting While Driving - OSHA

    Free

    Distribute this pamphlet to your employees that are required to drive. It explains the importance of not texting while driving.

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  • Unfair Labor Practice Charge Against Employer - NLRB Form 501

    Free

    This form is used to file an unfair labor practice charge against an employer.

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  • Unfair Labor Practice Charge Against Labor Organizations or its Agents - NLRB Form 508

    Free

    This form is used to file an unfair labor practice charge against an employee group or union.

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  • Unfair Labor Practice Charge Under Section 8(e) of the NLRA - NLRB Form 509

    Free

    This form is used to file an unfair labor practice charge against an employer, employee group or union.

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  • VETS-4212

    Free

    Certain federal contractors must file a VETS-4212 form. Reports must be filed between August 1, and September 30. The report is required on an annual basis.​​​​​

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  • Voluntary Self-Identification of Disability

    Free  |  Updated

    Federal regulations implementing Section 503 of the Rehabilitation Act of 1973 require certain federal contractors to ask applicants to voluntarily self-identify their disability status at both the pre-offer and post-offer phases of the application process and to invite  all employees to self-identify every five years. The rule applies to federal contractors and subcontractors that have 50 or more employees and a contract of $50,000. These contractors must develop an affirmative action program and solicit disability information. All invitations to self-identify must be made using this Voluntary Self-Identification of Disability form which is  provided by the Office of Federal Contract Compliance Programs.

    Any version of this form must be at least 11-pitch for font size (with the exception of the footnote and the burden statement which must be at least 10-pitch in size.) 

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  • W4 - Employees Withholding Allowance Certificate

    Free

    Use this required form to obtain information from an employee to determine the correct Federal income tax amount to withhold from his/her paychecks. ​​

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  • W4 - Employees Withholding Allowance Certificate - Spanish

    Free

    Use this required form to obtain information from an employee to determine the correct Federal income tax amount to withhold from his/her paychecks. ​​

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  • Wage and Employment Notice to Employees (Labor Code section 2810.5)

    Free

    Provide this form to all nonexempt employees at the time of hire. If any change is made to the information on this form, notify employees of the change in writing within seven calendar days after the time a change was made unless notice is provided in another writing required by law within seven days of the change.​​

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  • Wage and Employment Notice to Employees (Labor Code section 2810.5) - Spanish

    Free

    Provide this form to all nonexempt employees at the time of hire. If any change is made to the information on this form, notify employees of the change in writing within seven calendar days after the time a change was made. ​​

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  • Wage Order 01 - Manufacturing

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 1 regulates wages, hours, and working conditions in the Manufacturing Industry.

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  • Wage Order 01 - Manufacturing - Spanish

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of nonexempt employees in California. Order 1 regulates wages, hours, and working conditions in the Manufacturing Industry.

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  • Wage Order 02 - Personal Services

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 2 regulates wages, hours, and working conditions in the Personal Services Industry.

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  • Wage Order 03 - Canning Freezing and Preserving

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 3 regulates wages, hours, and working conditions in the Canning, Freezing, and Preserving Industry.

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  • Wage Order 04 - Professional Technical Clerical Mechanical and Similar Occupations

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 4 regulates wages, hours, and working  conditions in the Professional, Technical, Clerical, Mechanical, and similar occupations.

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  • Wage Order 05 - Public Housekeeping

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 5 regulates wages, hours, and working conditions in the Public Housekeeping Industry.

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  • Wage Order 06 - Laundry Linen Supply Dry Cleaning and Dyeing

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 6 regulates wages, hours, and working conditions in the Laundry, Linen Supply, Dry Cleaning, and Dyeing Industry.

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  • Wage Order 07 - Mercantile

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 7 regulates wages, hours, and working conditions in the Mercantile Industry.

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  • Wage Order 08 - Industries Handling Products After Harvest

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 8 regulates wages, hours, and working conditions in industries handling products after harvest.

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  • Wage Order 08 - Industries Handling Products After Harvest - Spanish

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of nonexempt employees in California. Order 8 regulates wages, hours and working conditions in industries handling products after harvest.

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  • Wage Order 09 - Transportation

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 9 regulates wages, hours, and working conditions in the Transportation Industry.

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  • Wage Order 10 - Amusement and Recreation

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 10 regulates wages, hours, and working conditions in the Amusement and Recreation Industry.

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  • Wage Order 11 - Broadcasting

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 11 regulates wages, hours, and working conditions in the Broadcasting Industry.

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  • Wage Order 12 - Motion Picture Industry

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 12 regulates wages, hours, and working conditions in the Motion Picture Industry.

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  • Wage Order 13 - Industries Preparing Agricultural Products for Market on the Farm

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 13 regulates wages, hours, and working conditions in industries preparing agricultural products for market, on the farm.

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  • Wage Order 13 - Industries Preparing Agricultural Products for Market on the Farm - Spanish

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of nonexempt employees in California. Order 13 regulates wages, hours and working conditions in industries preparing agricultural products for market, on the farm.

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  • Wage Order 14 - Agricultural Occupations

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 14 regulates wages, hours, and working conditions in agricultural occupations.

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  • Wage Order 14 - Agricultural Occupations - Spanish

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of nonexempt employees in California. Order 14 regulates wages, hours, and working conditions in agricultural occupations.

    Preview  |  Download

  • Wage Order 15 - Household Occupations

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 15 regulates wages, hours, and working conditions in household occupations.

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  • Wage Order 16 - On-site Construction Drilling Logging and Mining

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 16 regulates wages, hours, and working conditions in the On-site Construction, Drilling, Logging, and Mining Industries.

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  • Wage Order 17 - Miscellaneous Employees

    Free

    California’s Industrial Welfare Commission (IWC) Wage Orders regulate wages and hours of non-exempt employees in California. Order 17 regulates wages, hours, and working conditions for miscellaneous employees.

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  • Wage Orders - Business Occupation Listing

    Free

    This chart lists businesses and occupations, and their corresponding Wage Orders.

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  • Workers' Compensation Claim Form - DWC 1

    Free

    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 him /her complete the "Employee" section and then return the form to you. Give the employee the copy marked "Employee's Temporary Receipt," providing the employee with a dated copy when you have completed the form. All employees should also have received a pamphlet describing workers' compensation benefits and procedures to obtain them.​​

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  • Workers' Compensation Claim Form - DWC 1 - Chinese

    Free

    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 him /her complete the "Employee" section and then return the form to you. Give the employee the copy marked "Employee's Temporary Receipt," providing the employee with a dated copy when you have completed the form. All employees should also have received a pamphlet describing workers' compensation benefits and procedures to obtain them.​​ This form has been made available by the Department of Industrial Relations for use with non-English speaking employees.

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  • Workers' Compensation Claim Form - DWC 1 - Korean

    Free

    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 him /her complete the "Employee" section and then return the form to you. Give the employee the copy marked "Employee's Temporary Receipt," providing the employee with a dated copy when you have completed the form. All employees should also have received a pamphlet describing workers' compensation benefits and procedures to obtain them.​​ This form has been made available by the Department of Industrial Relations for use with non-English speaking employees.

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  • Workers' Compensation Claim Form - DWC 1 - Spanish

    Free

    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 him /her complete the "Employee" section and then return the form to you. Give the employee the copy marked "Employee's Temporary Receipt," providing the employee with a dated copy when you have completed the form. All employees should also have received a pamphlet describing workers' compensation benefits and procedures to obtain them.​​ This form has been made available by the Department of Industrial Relations for use with non-English speaking employees.

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  • Workers' Compensation Claim Form - DWC 1 - Tagalog

    Free

    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 him /her complete the "Employee" section and then return the form to you. Give the employee the copy marked "Employee's Temporary Receipt," providing the employee with a dated copy when you have completed the form. All employees should also have received a pamphlet describing workers' compensation benefits and procedures to obtain them.​​ This form has been made available by the Department of Industrial Relations for use with non-English speaking employees.

    Preview  |  Download

  • Workers' Compensation Claim Form - DWC 1 - Vietnamese

    Free

    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 him /her complete the "Employee" section and then return the form to you. Give the employee the copy marked "Employee's Temporary Receipt," providing the employee with a dated copy when you have completed the form. All employees should also have received a pamphlet describing workers' compensation benefits and procedures to obtain them.​​ This form has been made available by the Department of Industrial Relations for use with non-English speaking employees.

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  • Workers' Compensation Information and Assistance Offices

    Free

    Contact addresses and phone numbers for local DWC Information and Assistance Units. The I & A Unit provides information and assistance to employees, employers, insurance carriers and other interested parties concerning rights, benefits and obligations under California's workers' compensation laws.​

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  • Workplace Violence Factors and Control Checklist- OSHA

    Free

    This checklist can help employers identify present or potential workplace violence problems. It contains various factors and controls that are commonly encountered in retail establishments. Not all of the questions listed here fit all types of retail businesses, and this checklist does not include all possible topics specific businesses need. Employers should expand, modify, and adapt this checklist to fit their own circumstances.

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  • Workplace Violence Incident Report Form 1- OSHA

    Free

    This form can be used to gather information from a workplace violence incident. Employers should expand, modify,and adapt this form to fit their own circumstances.

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  • Workplace Violence Incident Report Form 2- OSHA

    Free

    This form can be used to gather information from a workplace violence incident. Employers should expand, modify,and adapt this form to fit their own circumstances.

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  • Workplace Violence Inspection Checklist- OSHA

    Free

     This checklist can help employers identify present or potential workplace violence problems. It contains various factors and controls that are commonly encountered in retail establishments. Not all of the questions listed here fit all types of retail businesses, and this checklist does not include all possible topics specific businesses need. Employers should expand, modify, and adapt this checklist to fit their own circumstances.

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  • Work-Related Injuries and Illnesses Log - Form 300

    Free

    You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, medical treatment beyond first aid, that are diagnosed by a physician or licensed health care professional, or meet any criteria listed in CCR Title 8 sec. 14300.8 through 14300.12. You must complete an Injury and Illness Incident Report (Cal/OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, call your local Cal/OSHA office for help.

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  • Work-Related Injuries and Illnesses Summary- Form 300A

    Free

    All establishments covered by 8 CCR sec. 14300 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the log to verify that the entries are complete and accurate before completing this summary. Post this Summary page from February 1 to April 30 of the year following the year covered by the form.

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