Employer's Report of Occupational Injury or Illness

The following is a Summary of Comments, received during the 45-Day Comment Period that ended on May 13, 2002, and Responses to those Comments.  The source and dates of the comments are provided along with the names and affiliations of the commenters.

Note: Unless a particular Response indicates otherwise, no action has been taken by the Division of Labor Statistics and Research ("DLSR") to amend the proposed regulations as a result of the comments.

General Comments:

Janet Selby, Workers' Compensation Manager, Contra Costa County Municipal Risk Management

Source of comment: Electronic mail dated April 20, 2002

Comment No. 1

The proposed amendments to the Form 5020 are minor and will allow employers to use it as an equivalent to the Cal/OSHA Form 301. For these reasons, this organization supports the proposed Revision 7.


DLSR appreciates the review of the proposed Form 5020, Revision 7 by Ms. Selby and her organization, and their support for the proposal.

Charlene Martens, Associate Governmental Program Analyst

Worker Health and Safety Branch, California Department of Pesticide Regulation.

Source of comment: Electronic mail dated April 26, 2002

Comment No. 2:

The Department of Pesticide Regulation has reviewed the proposed Form 5020 Revision 7 and found that it has no effect on the Worker Health and Safety Branch.


DLSR appreciates the review of the proposed regulation by the Worker Health and Safety Branch.

Frank Sanderson, Regional Manager, TOC Management Services

Source of comment: Letter dated April 26. 2002

Comment No. 3:

The commenter asks DLSR to retain the previous terminology, "regular full-time status" instead of "permanent" in section 37A of the form because it more accurately reflects the "Employment at Will" status in California.


The replacement of the terminology was an inadvertent editorial error. DLSR appreciates the time that the commenter spent in reviewing the proposal and concurs that the original terminology should be restored.

Sue Pacciorini, Director of Loss Prevention, ALPHA Fund

Source of comment: Letter dated May 10, 2002

Comment No. 4:

Ms. Pacciorini supports the use of bold type for the confidentiality statement and the use of shaded boxes to denote the fields containing confidential information.


The Division of Labor Statistics and Research appreciates the time taken by Ms. Pacciorini to review the proposal and for her comment in support of the overall proposal.

Comment No. 5:

Many of the field sizes are smaller than in the previous version of the form and lack check boxes for the yes or no responses that are specified in fields 14, 15, 16, 21, 23, 28, 39, 34, 37, 37a, and 39.


The proposed Form 5020 Revision 7 was prepared to show the content and format changes from Revision 6. The final version that is established by this rulemaking was intended to have the added convenience of check boxes and the maximum amount of space possible for employers to complete manually.

Comment No. 6:

Several headings, such as "employer", and other information items such as "FORM 5020 Revision 7 2002" would be better displayed if they are not entered in the cells. Also, there are a few typographical errors such as misspellings and incorrect punctuation marks.


DLSR appreciates the diligent effort made by Ms. Pacciorini in thoroughly reviewing the form and identifying the typographical and computer-generated errors that will be corrected in the finalized form. The final version of Form 5020 Revision 7 will be formatted in a way to optimize its appearance and utility.

Comment No. 7:

The indication of an employee having emergency room treatment should have a clarification for cases where emergency room physicians have evaluated and treated "routine" work-related injuries in the situations where employers do not have access to occupational health clinic services. Ms. Pacciorini proposes that the routine and emergency treatments be recorded separately by adding a checkbox for "routine services".


The introduction of changes to the 5020 were proposed in a manner that would conform as closely as possible to the forms and terminology established by Federal OSHA in its changes to the regulations applying to recording and reporting occupational injuries and illnesses. Federal OSHA mandated that each state OSHA program would collect data that is as consistent with the Federal forms as possible. Since the terminology, "routine services", does not have a basis or definition in the applicable standards, Sections 14300 through 14300.48, DLSR respectfully declines to make the recommended change at this time.

Comments made at the 13 May, 2002 Hearing

Steve O'Neill, Keenan Associates Claims Division

Source: Oral comment made at the May 13, 2002 Hearing

Comment No. 8:

It was not clear why the two questions were added to the Form 5020.


Revision 7 of the Form 5020 was intended to change Revision 6 of the Form to conform to the items of information that are on the OSHA and Cal/OSHA Form 301. This change would make the form acceptable as an equivalent to the Form 301. As explained in the Initial Statement of Reasons, Federal OSHA introduced the two questions referred to by Mr. O'Neill with the Form 301.

Comment No. 9:

It is not clear to the company who is responsible for restricting access to the areas designated as confidential on the proposed Revision 7, for example when the form is sent to DLSR or if the information is used by an employer to discuss safety issues with staff or the management staff, that are indicated by an injury. Removing the confidential information before sending the Form to DLSR would be an encumbrance for the employer or other claims handler. It would be easier to use the Form 301 and a separate form for worker's compensation claims.


The Form 301 did not introduce the requirement to protect confidential employee information from unrestricted access. The addition of the admonition that confidential information must be restricted was intended to emphasize the requirement and clarify who has access to the confidential items. The employer or other claims handler is responsible for assuring that confidential information is not released except as specified by the regulation. As noted in the instructions on Revision 7, the confidential information does not have to be withheld from DLSR. It is also important to emphasize that the corresponding confidential information on the Form 301 is subject to the same access restrictions that are specified in Revision 7 and should be handled accordingly. As noted in the ISOR, the Form 5020 was created to permit an employer or other claims handler to use a single form to report an occupational injury or illness to DLSR and the Division of Workers' Compensation (DWC), but its use is not required by this rulemaking. The employer is free to use the Form 301, and provide a separate form to report the incident to DWC.

End of Summary of Comments and Responses to 45-Day Notice