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Form 5330 for Palm Beach Florida: What You Should Know

Employee needs to contact the Employer at (name and phone number) and ask for a copy of Form 5020. If Employee dies in the course of employment or while an employee; Complete the Form 5020 (attached) ○ Completed By (type or print). Employee needs to notify the Employer of death in writing. If Employee dies by voluntary or involuntary act. Attachment — PDF (846.0 KB). Attachment: PDF Form 5020 (updated). In case of accident or when an employee dies; Work-Related Injury — Eliza Health Centers Part of the California Department of Industrial Relations. 1. Employer's Report of Occupational Injury‐Form 5020. 2. Complete the form. Attach (attached) to the completed Employer's Report of Occupational Injury‐Form 5020 For more information, call (916) 609‐3600. FINDING A SOLUTION Employees or prospective employees who believe they may need help identifying the type and location of work-related injury should contact their nearest California Workplace Safety Department (PSD). Contact numbers are listed at the bottom of this page. PSD are also available by calling, or visiting your local PSD office. If the injured worker or his or her family cannot be determined via any of these means please call the California Department of Industrial Relations (D.I.R.) at. The D.I.R. can provide a free and confidential report in addition to any other resources. California Workers' Compensation Law. Workers' compensation law. It applies to individuals and businesses who are injured or suffer an illness or injury on the job. If you have been injured from working on commercial projects, or your employer has a workers' compensation law requirement, contact the California Department of Industrial Relations (D.I.R.) at. California Occupational Safety and Health Administration (Cal/OSHA). California's OSHA program administers the federal Occupational Safety and Health Act of 1970, the Federal Mine Safety and Health Act of 1977, the Occupational Safety and Health Act (OSHA) of 1970, and the Americans with Disabilities Act in California (ADA). Workers' Compensation.

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