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FATALITY State of California EMPLOYER'S REPORT OF OCCUPATIONAL INJURY OR ILLNESS Please complete in triplicate (type if possible) Mail two copies to:
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State of California EMPLOYER'S REPORT OF, STATE OF CALIFORNIA, EMPLOYER, S REPORT, SUSPECTED CHILD ABUSE REPORT, State, REPORT OF NEW EMPLOYEES, REPORT, California, CALIFORNIA EMPLOYER, STATE OF CALIFORNIA Division of Workers’, STATE OF CALIFORNIA . Division of Workers’ Compensation. PRIMARY TREATING PHYSICIAN, CDSS, STATE COMPENSATION INSURANCE FUND OSHA, Internal Revenue Service