Form 5021 Doctor's First Report of Occupational Injury or Illness - California

What Is Form 5021?

This is a legal form that was released by the California Department of Industrial Relations - Division of Workers' Compensation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 5021?
A: Form 5021 is a document in California used to report occupational injuries or illnesses by a doctor.

Q: Who needs to fill out Form 5021?
A: The doctor who diagnoses or treats an occupational injury or illness needs to fill out Form 5021.

Q: Why is Form 5021 important?
A: Form 5021 is important because it helps to document and communicate occupational injuries or illnesses, and it is used for workers' compensation purposes.

Q: What information is required on Form 5021?
A: Form 5021 requires information such as the injured worker's personal details, nature of the injury or illness, and treatment provided.

Q: When should Form 5021 be submitted?
A: Form 5021 should be submitted as soon as possible after the diagnosis or treatment of the occupational injury or illness.

Q: Is Form 5021 confidential?
A: Yes, the information on Form 5021 is confidential and protected under privacy laws.

Q: What should I do if I have questions about Form 5021?
A: If you have questions about Form 5021, you should consult with your employer's workers' compensation insurance carrier or seek legal advice.