Form CCA-0004A Accident, Illness or Injury Report - Arizona (English / Spanish)

Form CCA-0004A Accident, Illness or Injury Report - Arizona (English / Spanish)

What Is Form CCA-0004A?

This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form CCA-0004A?
A: Form CCA-0004A is the Accident, Illness or Injury Report specifically for Arizona, available in both English and Spanish.

Q: What is the purpose of Form CCA-0004A?
A: The purpose of Form CCA-0004A is to report accidents, illnesses, or injuries that occur in Arizona.

Q: Is Form CCA-0004A available in Spanish?
A: Yes, Form CCA-0004A is available in both English and Spanish.

Q: Who should fill out Form CCA-0004A?
A: Form CCA-0004A should be filled out by anyone who needs to report an accident, illness, or injury that occurred in Arizona.

ADVERTISEMENT

Form Details:

  • Released on December 1, 2022;
  • The latest edition provided by the Arizona Department of Economic Security;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CCA-0004A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.

Download Form CCA-0004A Accident, Illness or Injury Report - Arizona (English / Spanish)

4.3 of 5 (18 votes)
  • Form CCA-0004A Accident, Illness or Injury Report - Arizona (English/Spanish)

    1

  • Form CCA-0004A Accident, Illness or Injury Report - Arizona (English/Spanish), Page 2

    2

  • Form CCA-0004A Accident, Illness or Injury Report - Arizona (English / Spanish), Page 1
  • Form CCA-0004A Accident, Illness or Injury Report - Arizona (English / Spanish), Page 2
Prev 1 2 Next
ADVERTISEMENT

Related Documents