Printable Form 5020 San Jose California 2025

Printable Form 5020 San Jose California: What You Should Know

Submit the same form to: (a.) The Supervisor of Workforce.  (b.) Area Hospital for Treatment of Injured Employees. (c.) The Office of the Medical Investigator. ’d.) The City Attorney's Office. (e.) The Office of Human Rights. (f.) Any other City agency in which the employer is registered to do business. If the City of San Jose does not own the business, then the City must contact The Supervisor of Workforce. If the injury does NOT involve serious injury as described in Section 7.1, 1.6, or 7.1. A.2.1 of this policy, and the injury/illness does not cause a permanent or serious reduction of a worker's ability to perform his/her job, then the employer is not required to file this form or fill out the form. (a.) If the business is located on an industrial property as described in Section 6.3. B.1, 1.1, 2.1, or 4.1.2 of this policy, and the injury/illness occurs on or in a factory, industrial building, warehouse, storage facility, or other facility as defined in Section 5.3. C.1 of this policy, (b.) If the injury/illness does not involve serious injury but involves a permanent or substantial interruption of a worker's ability to perform his/her job, the employer must file this form and fill out the report. (c.) If the injury/illness does not involve serious injury, but involves a decrease in a worker's ability to perform his/her job, the employer must complete Section 7.1. A, the relevant bulletins, but must fill out a new Form 5020 with items 1-8 completed and submit the new Form to the Supervisor of Workforce. ’d.) If the injury/illness does not involve serious injury, but involves a temporary inability to perform his/her job, the employer must fill out Section 7.1. A.1.2.  And submit the form to the Supervisor of Workforce. (e.) If the injury/illness does not involve serious injury, but involves a reduction in a worker's ability to perform his/her job, the employer must fill out Section 7.1. A.1.3.  And submit the form to the Supervisor of Workforce.

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