CA Worker's Compensation Claim Form (DWC1)

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INTRODUCTION

CA Workers' Compensation Claim Form (DWC1) is a document used to file a workers’ compensation claim if the employee is injured either physically or mentally because of the employee’s job.

For now, this is the only Worker's Compensation form the IMS is programmed to produce.

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SAMPLE REPORT

The sample report above includes a color key to indicate the record that data is pulling from to complete the report. 

• Yellow: User Record
• Salmon: Injuries Tab of the Incident Report
• Purple: Incident Tab of the Incident Report
• Turquoise: Establishment screen
• Green: Manual Entry

Click Sample Workers's Compensation Claim Form (DWC1) to view a completed report with color key.

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PRODUCING THE FORM

In order to produce this form you need to make sure the establishment is located in California and the incident type is Injury or Illness.

Follow these steps to make sure that all data fields that we automatically populate are completed:

1. Click the Administration tab at the top of the screen.
2. Click Incident Management, then Incidents on the left menu bar.
3. Incident Tab: The following entries must include: 
   1. Complete all required entries fields
   2. Incident Type: must be Injury or Illness
   3. Occurred On Date and Time: includes the date and time the accident occurred
   4. What Happened During the Incident: provide a description of how the incident occurred
4. People Tab: The following entries must include:
   1. Add an Injury: Add the person that was injured.
5. Injuries Tab: Add an Injury. Complete all applicable fields. The following entries must include (to complete the form):
   
   1. Injured Person: Select the injured person.
   2. What Was the Injury/Illness: Add a description of the injury or illness.
   3. Body Parts Injured: Include one or more affected body parts.
6. Save the incident.
7. Click the Forms button and select California Form DWC1 to run the form.
8. When California Form DWC1 screen appears: 
   1. Select the desired user from the drop down list.
   2. Check the box to print Page 1-3 of the instructions in addition to the form
   3. Click the View Form button.
   4. The form will appear on the screen.
9. If data on the form is missing or incomplete:
   1. Use the color key above to identify which record(s) to edit.
   2. Edit the record(s) to correct data or add missing data.
   3. Follow Steps 7-8a-d to run the form again
10. Click the Print Icon at the top of the screen and follow the on screen prompts to print the form.
11. Email Report - One Time: Refer to the Reports: Run, Print, Export and Email article to learn how to email the form one-time.
12. Email Report - Recurring: Refer to the Reports: Run, Print, Export and Email article to learn how to email the form on a recurring basis.

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