Transcription of State of California EMPLOYER'S REPORT OF …
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Example: bachelor of science
State of California EMPLOYER'S REPORT OF …
State of California Please complete in triplicate (type if possible) Mail two copies to: EMPLOYER'S REPORT OF occupational injury OR ILLNESSAny person who makes or causes to be made anyknowingly false or fraudulent material statement ormaterial representation for the purpose of obtaining ordenying workers compensation benefits or payments isguilty of a law requires employers to REPORT within five days of knowledge every occupational injury or illness which results in lost time beyond thedate of the incident OR requires medical treatment beyond first aid.
State of California Please complete in triplicate (type if possible) Mail two copies to: EMPLOYER'S REPORT OF OCCUPATIONAL INJURY OR ILLNESS Any person who makes or causes to be made any
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