Workers' Compensation Claim Kit - California

Attachments – Employee's Acknowledgment of Receipt, Witness Contact Sheet, and Customer Service Center Fax Cover Sheet (updated February 2011). DESCRIPTION OF FORMS. Workers’ Compensation Claim Form (DWC 1)& Notice of Potential Eligibility e3301( rev. 9/10) DWC 1 (rev. 6/10) ................
................