This information is provided free of charge by the Department of Industrial Relations from its web site at www.dir.ca.gov. These regulations are for the convenience of the user and no representation or warranty is made that the information is current or accurate. See full disclaimer at http://www.dir.ca.gov/od_pub/disclaimer.html.


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

New query
§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 Adobe Acrobat PDF Format(.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).

Go BackGo Back to Article 1 Table of Contents