Worker's Compensation Forms

Unfortunately, injuries do happen on the job. If you or an employee gets injured, you must complete both these forms:

  1. Form 5020
  2. DWC1 (give original to injured employee)

Complete both forms, sign, and fax to 818-546-8475. If you wish to email to, please do NOT enter your Social Security number on the form.

Upon receiving these forms, the Human Resources office will then file the claim with our worker's compensation administrator, Sedgwick . HR will give the original DWC1 form to  the injured employee to take to the healthcare provider so that the doctor can charge the visit to worker's compensation.