WebForm [DWC-AD 10133.35 “Notice of Offer of Work for Injuries Occurring On or After 1/1/13.”] §10133.36. Form [DWC-AD 10133.36 “Physician’s Return-to-Work & Voucher Report.”] § 10133.51. Notice of Potential Right to Supplemental Job Displacement Benefit. § 10133.52. Form [DWC-AD "Notice of Potential Right to Supplemental Job Displacement WebThe California claim form can also be downloaded here. Workers can contact the Department of Industrial Relations’ Information and Assistance Unit or by calling 1-800-736-7401. Once you have the claim form, fill out the “employee” section, sign and date it, and send it to your employer right away, keeping a copy for your records.
Workers
WebSection 10133.33 - Form [DWC-AD 10133.33 "Description of Employee's Job Duties Form."] Section 10133.34 - Offer of Work for Injuries Occurring on or After January 1, 2013; Section 10133.35 - Form [DWC-AD 10133.35 "Notice of Offer of Regular, Modified, or Alternative Work For injuries occurring on or after 1/1/13."] Web58 Workers’ Compensation in California Description of Employee’s Job Duties (DWC AD form 10133.33). A form that is filled out jointly by the injured worker and the employer or claims administrator to help the treating physician determine whether the worker is able to return to his or her usual job and working conditions. The information on lbm2 task 1: elementary science methods
DWC Form 10133.35 - CWCI
WebDivision of Workers' Compensation Subchapter 1.5. Injuries on or After January 1, 1990 Article 7.5. Supplemental Job Displacement Benefit . New Query §10133.33. Form … WebDec 31, 2024 · Do I sign this Dwc-ad 10133.35 form? My doctor has diagnosed me with carpal tunnel and believes it has been caused by my job, cutting hair. My doctor said i … WebDWC-AD form 10133.35 (SJDB) Jan 1, 2013 - Page 2 of 4 Draft 1. Yes. No Wages: $ Yes. No Actual job title: Yes. No Work location: Duties required of the position: Description of activities to be performed (if not stated in job description): Yes. No Per hour. Week. Month Position is for a different shift Same as Pre-Injury Position kelly green waffle shirt