California Department of Industrial Relations Forms

This Form is used for filing an initial report or claim under the Workers' Compensation Act in California.

This form is used for reporting an initial work-related injury or making a claim in California. It is available in Korean.

This Form is used for requesting a Qualified Medical Evaluator (QME) panel under Labor Code 4062.2 in California. It is specifically for injuries that occurred prior to January 1, 2005 and when the injured person is represented by an attorney.

This document is for unrepresented employees in California who are seeking a Qualified Medical Evaluator (QME) panel. It provides instructions on how to request the panel and guides the employee through the process.

This document is used for submitting a pre-trial conference statement in California workers' compensation cases.

This form is used for requesting an expedited hearing (trial) in the state of California.

This document is a petition for California residents seeking benefits due to serious and willful misconduct by their employer. It is filed under Labor Code Section 4553.

This form is used to notify the Workers' Compensation Appeals Board in California of the dismissal of an attorney in a workers' compensation case.

This document is used for verification of serious and willful misconduct by an employer in accordance with Labor Code Section 4553 in California. It is a legal form for reporting and addressing such misconduct.

This Form is used for Employee's Disability Questionnaire in California.

This form is used for petitioning to change your primary treating physician in California's workers' compensation system.

This type of document is a supplemental job displacement non-transferable voucher form for injuries occurring in California after January 1, 2013. It is specifically for Chinese speakers.

This form is used for disclosing the reimbursement rate of a contract in California.

This document is a form used in California for third party compromise and release. It is used to settle any disputes between the injured worker, employer, and the workers' compensation insurance carrier.

This document is used for requesting documents or evidence to be brought to a court hearing in California.

This form is used for issuing a subpoena to compel a witness to give a deposition in a legal case in California.

This form is used for individuals in California who want to obtain permission to work in the entertainment industry.

This document is used in California for submitting stipulations along with a request for an award in a workers' compensation case.

This Form is used for providing information about public works contract awards in California.

This form is used for requesting the dispatch of an apprentice in the state of California.

This Form is used for reporting the annual summary of work-related injuries and illnesses in California as required by Cal/OSHA.

This form is used for logging work-related injuries and illnesses in California. It is a part of the Cal/OSHA Form 300 Appendix A.

This form is used for reporting workplace injuries and illnesses in California. It is required by Cal/OSHA and is used to provide information about the incident, such as the date, time, and cause of the injury or illness.

This form is used for providing a notice to employees in California. It may contain important information regarding employment rights, wage payments, or other legal requirements.

This document is used in California to provide employees with a notice (in Spanish) regarding their rights and protections in the workplace.

This form is used for Farm Labor Contractors in California to provide a statement of pay rates to their employees. It is available in both English and Spanish.

This form is used for submitting an appeal to the Occupational Safety and Health Appeals Board in California.

This form is used for California piece rate workers to request a check. It is available in both English and Spanish.

This form is used for reporting payroll information related to public works projects in the state of California. It is required by the California Department of Industrial Relations to ensure proper payment of wages on these projects.

This form is used for employers in California to report occupational injuries or illnesses to the relevant authorities.

This form is used for the verification process required before filing a lien claim in California. It ensures that the claimant has valid grounds to file the lien and provides supporting documentation.

This document is used for filing an appeal of a decision made by the Administrative Director in the state of California.

This document is a guide provided by the Information & Assistance Unit in California for filing a workers' compensation claim. It provides step-by-step instructions on how to fill out the claim form, known as Form I&A1.