Worker's Comp Forms

Unfortunately, injuries do happen on the job. If you or an employee gets injured. you must fill both these forms out:

  1. Form 5020
  2. DWC1 (give original to injured employee)

Complete both forms, sign, and fax to 818-546-8475 or email to hr@sccsda.org.

The Human Resources office will then file a worker's comp claim with Sedgwick upon receiving these forms. Give the original DWC1 to the injured employee to take  to the hospital (this acts as an insurance card so that the medical provider will charge the visit to worker's comp).