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DIVISION OF LABOR STANDARDS ENFORCEMENT
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www.dir.ca.govDepartment of Industrial Relations Division of Occupational Safety and Health Cal/OSHA Form 300 (Rev. 7/2007) Appendix A Year 20__ __ Log of Work-Related Injuries and Illnesses
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www.dir.ca.govRev. 1/1/2016 Page 2 of 3 your employer or the claims administrator has not created or selected an MPN. Disclosure of Medical Records: After you make a claim for workers'
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