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Forms

       For your convenience, the following forms are available to download and print.*  

    Form #
  Guide to the State Fund Medical Provider Network for State of California Employees (English/Spanish) [456 k] e13174
  Guide to Workers' Compensation for New State of California Employees [1.05 MB] e13546
  Guide to Workers' Compensation for State of California Employees [98 MB] e13547
  Employer's First Report of Occupational Injury or Illness Form [264 k] 3067e
  Employee's Claim for Workers' Compensation Benefits (English/Spanish) [412 k] 3301
  Safety Material Order Form [136k]  
  Audio-Visual Request Form [104 k]  
  Posting Notice (English) [224 k] e13913
  Posting Notice (Spanish) [200 k] e13914

*You will need Adobe's Acrobat Reader to view and print State Fund PDF forms and documents. Click on the image to the right to download the latest reader free of charge from Adobe Systems.

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