Form 5020 for Murrieta California 2025

Form 5020 for Murrieta California: What You Should Know

All other Forms 5020 (Rev7) JUNE 2025 are filed at the same time (Filing date does not matter). For questions or assistance with this filing, please call the agency that filed this form. Employer's Report of Occupational Injury or Illness (Form 5020) _____ Date of Form 5020(r) Submission to the California Department of Industrial Relations (in this Form) Form 5020 (Rev 7) JUNE 2002. DATED: _____ / ______________________ (name of the payee) (address and TIN) _________________________ (e.g., Employer's Report of Occupational Injury or Illness (Form 5020) dated ___/____/2002 [this Form was filed by the Los Angeles Department of Consumer and Governmental Affairs on June 26, 2002](/e)) Form 5020 (Rev 7) JUNE 2002. (Signature of Worker) _____________________ Form 5230, Workers' Compensation/Insurance Report. This form may be sent with the Form 5020 (JUNE 2002) filing. (If this form is filled out and filed prior to the Form 5020 (JUNE 2 10 2002) filing date for an accident on or after the June 7, 2002, date, you can complete this form during that filing. It can be filled out and mailed to insurance companies who report this form.) Attachment: Form 5230 (Signature of Workers' Compensation Administrator). (b) Each covered employee and employee of an employer under a group or joint venture, and covered individual in a family covered by this Act shall complete another separate, self-contained form to be filed by: [These forms should be filed with Form 5020 (JUNE 2002). All forms, except the following, are filed at the same time (Filing date does not matter).] Employee's Statement in Connection With  Workers' Compensation Coverage. Attachment: Letter of Authorization for Worker's Compensation Coverage form. (Signature of Worker.) Employee's Statement in Connection With  Group or Joint Venture Coverage. Attachment: Group or Joint Venture Coverage form. (Signature of Worker.) Individual's Statement in Connection with  Covered Individual's Group or Joint Venture, Group, Or Joint Venture Coverage. Attachment: Notice of Group or Joint Venture Coverage form. (Signature of Worker.) PART OF BODY. (e.g.

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