This information is provided free of charge by the Department of Industrial Relations from its web site at 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

Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 10. Employee Death, Notice Of

New Query

§9914. Reproduction of Form 510, Notice of Employee Death.

(a) Employers and insurers may reproduce DIA Form 510, in which the heading may be rearranged to permit printing of:

(1) The insurance carrier's or employer's name, address and telephone number.

(2) Instructions for forwarding the form and number of copies required.

(b) The spacing, arrangement, sequence or language shall not otherwise be altered.


1. Amendment filed 7-11-73 as an emergency; effective upon filing. Certificate of Compliance included (Register 73, No. 28).

Go BackGo Back to Article 10 Table of Contents