All Forms

Mandated Forms

• Employee’s Guide to the State Fund MPN (English/Spanish) e13176
• Employee’s Guide to the State Fund MPN for Claims Management Service (English/Spanish) e13177
• MPN Implementation Notice (English/Spanish) e3841
• MPN Implementation Notice - State Contract Services (English/Spanish) e3843
• New Employee’s Guide to Workers’ Compensation (English/Spanish) e13286
• Notice to Employees (English) e13708
• Notice to Employees (Spanish) e13709

Downloadable Forms

• Employer's First Report of Injury  e3067
• Express Scripts Pharmacy Registration Form
• Medical Mileage Expense Form e3065
• Safety Materials Order Form e17614
• Workers' Compensation Claim Form (DWC 1) e3301
  

Informational Materials

• 10 Steps to Lower Workers' Compensation Costs e13726
• ACORD 130 (Non-Broker Accounts) ACORD 130
• An Ergonomic Primer on Office Lighting
• Association Membership with State Fund e13219
• Audit Questions and Answers e13649
• Classifications by Wage Level in the Construction Industry e13721
• Classifications by Wage Level in the Construction Industry (Spanish) e13722
• Corporate Officers or Directors Exclusion Letter e10201
• Developing and Maintaining a Successful Return to Work Program e13490
• Directory of Workers' Compensation Administrators by State
• Experience Modification Rating e13702
• Find it Fast and Easy Online, 24/7 e13986
• For Employers: Developing a Successful Return to Work Program e13088
• For Employers: Facts for the California Employer e13701
• For Employers: Return to Work Programs (brochure) e13089
• Group Insurance Savings and Opportunities e13400
• Information Sharing Disclosure (Privacy Policy) e26000
• Limited Liability Company Exclusion Letter e10202
• Making a Successful Return To Work e13090
• Modified Jobs, Reduced Costs e13720
• New Concepts in Seating
• New Requirements for Separate Classifications by Wage Level in the Construction Industry e14296
• Notice Of Temporary Staffing Client Letter e10383
• Partnership Exclusion Letter e10200
• Reporting An Injury e13704
• Return to Work Programs e13891
• Safety Audio Visual Catalog e17804
• Safety Materials Catalog e17805
• Sample Ergonomics Program
• Small Employer Safety Materials Catalog e17839
• State Compensation Insurance Fund - California's Workers' Compensation Specialist e13837
• State Fund Online e13893
• State Fund-Farm Bureau Group Program e13395
• State Fund's Financial Strength and Lasting Value e13646
• Supplemental Application Form (SAF) e10328
• Understanding First Aid Claims e13492
• Understanding Your Annual Rating Endorsement e10350
• Understanding Your Declarations Page e10355
• Understanding Your Final Premium Bill e10170
• Understanding Your Policy Surcharges e13724
• Understanding Your Quote for Insurance e10502
• Utilization Review Plan [Effective 01/26/11]  
• Your Guide to Workers’ Compensation (English/Spanish) e13699