Chapter 7. Division of Labor Statistics and Research
Subchapter 1. Occupational Injury or Illness Reports and Records

Article 1. Reporting of Occupational Injury or Illness

§14006. Form 5021, Rev. 4, Doctor's First Report of Occupational Injury or Illness.

Form 5021, Doctor's First Report of Occupational Injury or Illness (.pdf format, 16K)

NOTE: Authority cited: Sections 6409(a), 6410, 6410.5 and 6413.5, Labor Code; and Section 2950, Health and Safety Code. Reference: Sections 5401.7 and 6410, Labor Code.

HISTORY

1. New section filed 2-8-80; designated effective 5-1-80 (Register 80, No. 6).

2. Repealer and new section filed 6-14-89; operative 7-14-89 (Register 89,No. 25).

3. Repealer and new section filed 1-14-93; operative 2-16-93 (Register 93, No. 3).

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