Form 5020-2026

See details

4 out of 5

21 votes

The document is the 'Employer's Report of Occupational Injury or Illness' for the State of California, which outlines the legal requirements for employers to report workplace injuries or illnesses. It mandates reporting within five days for incidents resulting in lost time or requiring medical treatment, and includes specific instructions on completing the form, including details about the injured employee, nature of the injury, and employer information. The document emphasizes the importance of accuracy in reporting to avoid felony charges for false statements.

Here's how it works

01. Edit your form 5020 online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send california form 5020 fillable via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out form 5020 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by entering the Firm Name and Policy Number in the designated fields. Ensure accuracy as this information is crucial for processing.
Fill in the Mailing Address and Location if different. This helps ensure that all correspondence reaches the correct destination.
Indicate the Nature of Business, which provides context for the injury or illness reported.
Complete the Date of Injury/Onset of Illness and Time fields accurately, as these are critical for compliance with reporting regulations.
Answer questions regarding work status post-injury, including whether the employee was unable to work and dates related to their return.
Detail the Specific Injury/Illness and describe how it occurred in Section 26. This section may require careful thought to ensure clarity.
Finally, review all entries for accuracy before submitting your completed form through our platform.

Start using our editor today to complete form 5020 quickly and efficiently!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do you document an employee injury?

How to Document a Workplace Injury Get to the site as quickly as possible. Ensure the area is safe to enter. Make sure the injured/ill person is receiving first-aid or medical attention. Identify any witnesses. Record the scene with photos (ideally with date and time stamp) or sketches. Safeguard any evidence.

Can I sue my employer for not reporting my injury in California?

Section 3700.5 of the California Labor Code makes it a misdemeanor punishable by either a fine of not less than $10,000 or imprisonment in the county jail for up to one year, or both.

What happens if an employer does not report an injury?

Fatality and Severe Injury Reporting Employers must report any worker fatality within 8 hours and any amputation, loss of an eye, or hospitalization of a worker within 24 hours. Your browser cant play this video. An error occurred.

How long does an employer have to report an injury in California?

California law requires employers to report within five days of knowledge every occupational injury or illness which results in lost time beyond the date of the incident OR requires medical treatment beyond first aid.

What is the most common injury claim on Workmans Comp?

According to OSHA and the National Safety Council (NSC), some of the most common include: Muscle sprains, strains, and tears. Bone fractures. Cuts, lacerations, and punctures. Repetitive strain or stress (RSIs), such as carpal tunnel, tendonitis, and back pain. Slips, trips, and falls.

5020 form

Printable form 5020 Form 5020 PDF Form 5020 instructions Form 5020 Spanish Form 5020 fillable Form 5021 Form 5020 template EMPLOYER'S REPORT of Occupational injury or illness Form 5020

What is the 5020 form?

The Employers Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.

How long do you have to report an injury at work in California?

No you cant sue them for not reporting because anyone can report their claim. You will need a hearing to determine compensability, and the wc board will decide if it is work related or not.