Workers' Compensation and Employee Safety

Workers Compensation Forms for Employees

  1. Acknowledgement of Receipt (PDF)
  2. Contact Information For Company Nurse (PDF)
  3. Notice to Employees - Injuries Caused By Work and Coverage-Carrier Information (DWC-7) (PDF)
  4. WC-5020 Employers Report of Injury or Illness (PDF)
  5. Workers' Compensation Claim Form (DWC 1) (PDF)
  6. Workers' Compensation Claim Waiver Form (PDF)

Employee Safety and Information

  1. California Osha Form 300 (PDF)
  2. County of Humboldt COVID-19 Prevention Plan (CPP)- FINAL 2021-02-16
  3. GISO 3204(2) - Access to Medical and Exposure Records (PDF)
  4. IWC - Industrial Welfare Commission (PDF)
  5. Workers Compensation - If a Work Injury Occurs (PDF)

Fire District Workers Compensation Program

The following forms must completed and be returned with payment to be included in the County's annual Workers Compensation Program. Renewal packets are distributed July 1st each year and due by August 1st. 

Please email completed documents to:      

Compliance with the County's training requirements and physical exams requirements is also required. For additional information about what those requirements are, please see the resources below: