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SJSU Home>Human Resources>All Forms>Workers’ Compensation

Workers’ Compensation

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  • Employer's Report of Occupational Injury or Illness (.pdf)
  • Notice of Personal Chiropractor or Acupuncturist (.pdf)
  • Notice of Pre-designation of Personal Physician (.pdf)
  • Occupational Injury or Illness Reporting (.pdf)
  • Workers' Compensation Benefit Information (.pdf)
  • Workers' Compensation Claim Form (DWC 1) and Notice of Potential Eligibility (.pdf)
  • Workers' Compensation Occupational Injury or Illness Checklist (.pdf)

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Last Modified: Oct 12, 2016