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7. Location where treatment was provided;
8. Whether the employee was treated in an emergency room; and
9. Whether the employee was hospitalized overnight as an in-patient.
(F) May I charge for the copies?
No. You may not charge for these copies the first time they are provided. However, if one of the designated persons asks for additional copies, you may assess a reasonable charge for retrieving and copying the records.
(c) With the exception of provisions to protect the privacy of employees in subsections (b)(2)(D) and (b)(2)(E) of this section and in subsections (b)(6) through (b)(10) in Section 14300.29, nothing in this section shall be deemed to preclude employees and employee representatives from collectively bargaining to obtain access to information relating to occupational injuries and illnesses in addition to the information made available under this section.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.36. Prohibition Against Discrimination.
Section 11(c) of the Act and Sections 6310 and 6311 of the Labor Code prohibit you from discriminating against an employee for reporting a work-related fatality, injury, or illness. These provisions of the Labor Code also protect the employee who files a safety and health complaint, asks for access to records required by this article, or otherwise exercises any rights afforded by the Act or Sections 6310 and 6311 of the Labor Code.
Note: Authority cited: Sections 50.7 and 6410, Labor Code. Reference: Sections 50.7, 98.7, 6310, 6311 and 6410, Labor Code.
s 14300.38. Variances from the Recordkeeping Rule.
(a) Basic requirement for private employers. If you are a private employer and wish to keep records in a different manner from the manner prescribed by the provisions of this article, you may submit a variance petition to the Assistant Secretary of Labor for Occupational Safety and Health (Assistant Secretary), U. S. Department of Labor, Washington, DC 20210. You can obtain a variance only if you can show that your alternative recordkeeping system:
(1) Collects the same information as this article requires;
(2) Meets the purposes of the Act; and
(3) Does not interfere with the administration of the Act.
(b) Implementation of the basic requirement for private employers.
(1) What do I need to include in my variance petition?
You must include the following items in your petition:
(A) Your name and address;
(B) A list of the State(s) where the variance would be used;
(C) The address(es) of the establishment(s) involved;
(D) A description of why you are seeking a variance;
(E) A description of the different recordkeeping procedures you propose to use;
(F) A description of how your proposed procedures will collect the same information as would be collected by the provisions of this article and achieve the purpose of the Act; and
(G) A statement that you have informed your employees of the petition by giving them or their authorized representative a copy of the petition and by posting a statement summarizing the petition in the same way as notices are posted under Title 8 Section 340.
(2) How will the Assistant Secretary handle my variance petition?
The Assistant Secretary will take the following steps to process your variance petition.
(A) The Assistant Secretary will offer your employees and their authorized representatives an opportunity to submit written data, views, and arguments about your variance petition.
(B) The Assistant Secretary may allow the public to comment on your variance petition by publishing the petition in the Federal Register. If the petition is published, the notice will establish a public comment period and may include a schedule for a public meeting on the petition.
(C) After reviewing your variance petition and any comments from your employees and the public, the Assistant Secretary will decide whether or not your proposed recordkeeping procedures will meet the purposes of the Act, will not otherwise interfere with the Act, and will provide the same information as required by the provisions of this article provide. If your procedures meet these criteria, the Assistant Secretary may grant the variance subject to such conditions as he or she finds appropriate.
(D) If the Assistant Secretary grants your variance petition, OSHA will publish a notice in the Federal Register to announce the variance. The notice will include the practices the variance allows you to use, any conditions that apply, and the reasons for allowing the variance.
(3) If I apply for a variance, may I use my proposed recordkeeping procedures while the Assistant Secretary is processing the variance petition?
No. Alternative recordkeeping practices are only allowed after the variance is approved. You must comply with the provisions of this article while the Assistant Secretary is reviewing your variance petition.
(4) If I have already been cited by the Division of Occupational Safety and Health for not following the provisions of this article, will my variance petition have any effect on the citation and penalty?
No. In addition, the Assistant Secretary may elect not to review your variance petition if it includes an element for which you have been cited and the citation is still under review by a court, an Administrative Law Judge (ALJ), or the California Occupational Safety and Health Appeals Board.
(5) If I receive a variance, may the Assistant Secretary revoke the variance at a later date?
Yes. The Assistant Secretary may revoke your variance if he or she has good cause. The procedures revoking a variance will follow the same process as are used for reviewing variance petitions, as outlined in Section 14300.38(b)(2). Except in cases of willfulness or where necessary for public safety, the Assistant Secretary will:
(A) Notify you in writing of the facts or conduct that may warrant revocation of your variance; and
(B) Provide you, your employees, and authorized employee representatives with an opportunity to participate in the revocation procedures.
(c) Variances from the recordkeeping rule for public employers. A public agency employer wishing to keep records in a different manner from the manner prescribed in this article may write a letter to the Chief of the Division of Labor Statistics and Research stating his or her request. Such requests should include the information described in subsection (b)(1) of this section for private employer requests for variances from requirements of this article. The provisions of subsections (b)(2) through (b)(5) of this section will also apply to variance requests from public agency employers except that the determining authority will be the Chief of the Division of Labor Statistics and Research.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.40. Providing Records to Government Representatives.
(a) Basic requirement. When an authorized government representative asks for the records you keep under the provisions of this article, you must provide within four (4) business hours, access to the original recordkeeping documents requested as well as, if requested, one set of copies free of charge.
Exception: If your establishment is in SIC Code 781, you must make a reasonable effort to comply as required by this section within 4 business hours of receiving the request. If it is not possible to comply with that deadline with reasonable effort, you must comply no later than by the end of the next business day.
(b) Implementation.
(1) What government representatives have the right to get copies of the records I keep as required by Article 2?
The government representatives authorized to receive the records are:
(A) A representative of the Chief of the Division of Occupational Safety and Health, or of the Director of the Department of Health Services;
(B) A representative of the Secretary of the U.S. Department of Labor conducting an inspection or investigation under the Act; and
(C) A representative of the Secretary of the U.S. Department of Health and Human Services (including the National Institute for Occupational Safety and Health - NIOSH) conducting an investigation under Section 20(b) of the Act;
(2) Do I have to produce the records within four (4) hours if my records are kept at a location in a different time zone?
Your response will be considered to be timely if you give the records to the government representative within four (4) business hours of the request. If you maintain the records at a location in a different time zone, you may use the business hours of the establishment at which the records are located when calculating the deadline.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.41. Annual OSHA Injury and Illness Survey.
(a) Basic requirement. If you receive OSHA's annual survey form, you must fill it out and send it to OSHA or OSHA's designee, as stated on the survey form. You must report the following information for the year described on the form:
(1) the number of workers you employed;
(2) the number of hours worked by your employees; and
(3) the requested information from the records that you keep under the provisions of this article.
(b) Implementation.
(1) Does every employer have to send data to OSHA or its designee?
No. Each year, OSHA or its designee sends injury and illness survey forms to employers in certain industries. In any year, some employers will receive an OSHA survey form and others will not. You do not have to send injury and illness data to OSHA or its designee unless you receive a survey form.
(2) How quickly do I need to respond to an OSHA survey form?
You must send the survey reports to OSHA or its designee by mail or other means described in the survey form, within 30 calendar days, or by the date stated in the survey form, whichever is later.
(3) Do I have to respond to an OSHA survey form if I am normally exempt from keeping OSHA injury and illness records?
Yes. Even if you are exempt from keeping injury and illness records under Section 14300.1 to Section 14300.3, OSHA or its designee may inform you in writing that it will be collecting injury and illness information from you in the following year. If you receive such a letter, you must keep the injury and illness records required by this article and make a survey report for the year covered by the survey.
(4) Do I have to answer the OSHA survey form if I am located in a State-Plan State?
Yes. All employers who receive survey forms must respond to the survey, even those in State-Plan States.
(5) Does this section affect the Division of Occupational Safety and Health's authority to inspect my workplace?
No. Nothing in this section affects the Division of Occupational Safety and Health's statutory authority to investigate conditions related to occupational safety and health.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.42. Requests from the Bureau of Labor Statistics for Data.
(a) Basic requirement. If you receive a Survey of Occupational Injuries and Illnesses Form from the Bureau of Labor Statistics (BLS), or a BLS designee, you must promptly complete the form and return it following the instructions contained on the survey form.
(b) Implementation.
(1) Does every employer have to send data to the BLS?
No. Each year, the BLS sends injury and illness survey forms to randomly selected employers and uses the information to create the Nation's occupational injury and illness statistics. In any year, some employers will receive a BLS survey form and others will not. You do not have to send injury and illness data to the BLS unless you receive a survey form.
(2) If I get a survey form from the BLS, what do I have to do?
If you receive a Survey of Occupational Injuries and Illnesses Form from the Bureau of Labor Statistics (BLS), or a BLS designee, you must promptly complete the form and return it, following the instructions contained on the survey form.
(3) Do I have to respond to a BLS survey form if I am normally exempt from keeping injury and illness records as required by this article?
Yes. Even if you are exempt from keeping injury and illness records under one or more of the provisions of Section 14300.1 to Section 14300.3, the BLS may inform you in writing that it will be collecting injury and illness information from you in the coming year. If you receive such a letter, you must keep the injury and illness records required by this article and make a survey report for the year covered by the survey.
(4) Do I have to answer the BLS survey form if I am located in a State-Plan State?
Yes. All employers who receive a survey form must respond to the survey, even those in State-Plan States.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.43. Annual Summary and Posting of the 2001 Data.
(a) Basic requirement. If you were required to keep Cal/OSHA Form 200 in 2001, you must post a 2001 annual summary from the Cal/OSHA Form 200 of occupational injuries and illnesses for each establishment.
(b) Implementation.
(1) What do I have to include in the annual summary?
(A) You must include a copy of the totals from the 2001 Cal/OSHA Form 200 Log and Summary and the following information from that form:
1. The calendar year covered;
2. Your company name;
3. The name and address of the establishment; and
4. The certification signature, title and date.
(B) If no injuries or illnesses occurred at your establishment in 2001, you must enter zeros on the totals line and post the 2001 annual summary.
(2) When am I required to summarize and post the 2001 information?
(A) You must complete the annual summary by February 1, 2002; and
(B) You must post a copy of the annual summary in each establishment in a conspicuous place or places where notices to employees are customarily posted. You must ensure that the annual summary is not altered, defaced or covered by other material.
(3) You must post the 2001 annual summary from February 1, 2002 to March 1, 2002.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.44. Retention and Updating of Old Forms.
You must save your copies of the Cal/OSHA 200 forms and supplementary records for each occupational injury or illness for five years following the year to which they relate and continue to provide access to the data as though these forms were the Cal/OSHA 300 and 301 forms, as provided for in Section 14300.35 and Section 14300.40. You are not required to update your old Cal/OSHA 200 forms and supplementary records.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.46. Definitions.
The Act. The Act means the federal Occupational Safety and Health Act of 1970 (29 U.S.C. 651 et seq.). The definitions contained in Section 3 of the Act (29 U.S.C. 652) and related interpretations apply to such terms when used in this article.
Authorized representative. See subsection 14300.35(b)(2)(A).
BLS. The Bureau of Labor Statistics in the U. S. Department of Labor.
Cal/OSHA. The California Occupational Safety and Health Program within the California Department of Industrial Relations.
Company. A public or private employer.
Covered employees. See Section 14300.31.
Equivalent form. See subsection 14300.29(b)(4).
Establishment. An establishment is a single physical location where business is conducted or where services or industrial operations are performed. For activities where employees do not work at a single physical location, such as construction; transportation; communications, electric, gas and sanitary services; and similar operations, the establishment is represented by main or branch offices, terminals, stations, etc. that either supervise such activities or are the base from which personnel carry out these activities.
(A) Can one business location include two or more establishments? Normally, one business location has only one establishment. Under limited conditions, the employer may consider two or more separate establishments that share a single location to be separate establishments. An employer may divide one location into two or more establishments only when:
1. Each of the establishments represents a distinctly separate business;
2. Each establishment is engaged in a different economic activity;
3. No one industry description in the Standard Industrial Classification Manual (1987) applies to the joint activities of the establishments; and
4. Separate reports are routinely prepared for each establishment on the number of employees, their wages and salaries, sales or receipts, and other business information. For example, if an employer operates a construction company at the same location as a lumberyard, the employer may consider each business to be a separate establishment.
(B) Can an establishment include more than one physical location?
Yes, but only under certain conditions. An employer may combine two or more physical locations into a single establishment only when:
1. The employer operates the locations as a single business operation under common management;
2. The locations are all located in close proximity to each other; and
3. The employer keeps one set of business records for the locations, such as records on the number of employees, their wages and salaries, sales or receipts, and other kinds of business information. For example, one manufacturing establishment might include the main plant, a warehouse a few blocks away, and an administrative services building across the street.
(C) If an employee telecommutes from home, is his or her home considered a separate establishment?
No. For employees who telecommute from home, the employee's home is not an establishment and a separate Cal/OSHA Form 300 is not required. Employees who telecommute must be linked to one of your establishments under Section 14300.30(b)(3).
Fatality. Any occupational injury or illness which results in death, regardless of the time between injury and death, or the length of the illness.
First aid. See subsection 14300.7(b)(5)(B).
General recording criteria. See Section 14300.7.
Injury or illness. An injury or illness is an abnormal condition or disorder. Injuries include cases such as, but not limited to, a cut, fracture, sprain, or amputation. Illnesses include both acute and chronic illnesses, such as, but not limited to, a skin disease, respiratory disorder, or poisoning. (Note: Injuries and illnesses are recordable only if they are new, work-related cases that meet one or more of recording criteria provisions in this article.)
Job transfer. See subsection 14300.7(b)(4).
Medical treatment. See subsection 14300.7(b)(5)(A).
New case. See Section 14300.6.
OSHA. The Occupational Safety and Health Administration in the U. S. Department of Labor.
Personal representative. See subsection 14300.35(b)(2)(B).
Physician or other licensed health care professional. A physician or other licensed health care professional is an individual whose legally permitted scope of practice (i.e., license, registration, or certification) allows him or her to independently perform, or be delegated the responsibility to perform, the activities described by this regulation.
Pre-existing condition. See subsection 14300.5(b)(5).
Privacy concern case. See subsection 14300.29(b)(6.
Recordable. An injury or illness is "recordable" for the purposes of this article if it satisfies the conditions requiring recording found in subsection (a) of Section 14300.4.
Routine functions. See subsection 14300.7(b)(4)(B).
Restricted work. See subsection 14300.7(b)(4)(A).
Significant injury or illness. See subsection 14300.7(b)(7).
Work environment. See subsection 14300.5(b)(1).
You. "You" means an employer as defined by Sections 3300 and 3301 of the Labor Code.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.47. Recordkeeping Requirements for Employers Covered by the Federal Mine Safety and Health Act.
Employers whose employees' occupational injuries and illnesses are required to be recorded under the Federal Mine Safety and Health Act of 1977 are not required to comply with the recordkeeping requirements of this article to the extent that so complying would result in duplicating information, provided access to the records required by Code of Federal Regulations, Title 30, Chapter 1, Subchapter I, commencing with Section 50.20 is granted to authorized representatives of the official mine safety agency of the State.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14300.48. Effective Date.
The provisions of this article take effect on January 1, 2002 or on the effective date of the regulation, whichever is later.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
Appendix A Cal/Osha Form 300 (Rev. 4/2004) Log of Work-Related Injuries and Illnesses
Appendix B Cal/Osha Form 300A (Rev. 4/2004) Annual Summary of Work-Related Injuries and Illnesses
Appendix C Injury and Illness Incident Report
Appendix D - Required Elements for the Cal/OSHA 300 Equivalent Form
I. California employers who are required to record work-related injuries and illnesses on the Cal/OSHA Form 300 (Rev. 4/2004) may use an equivalent form that includes all of the following instructions and information.
Log of Work-Related Injuries and Illnesses
Instruction: You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 8 CCR 14300.8 through 14300.12. Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (Cal/OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, contact the nearest office of the Division of Occupational Safety and Health for assistance.
Establishment Name & Address
Identify the Person (A)-(C)
A. Case Number
B. Employee's Name
C. Job Title
Describe the Case (D)-(F):
D. Date of Injury or illness
E. Where the event occurred
F. Describe the injury or illness, part(s) of the body affected, and object/substance that directly injured or made the person ill
Classify the Case (G)-(M)
Using these four categories (G)-(J), indicate only the most serious result for each case:
G. "Death"
H. "Days away from work"
I. Remained at work as "Other recordable cases"
J. Remained at work with "Job transfer or restriction"
Enter the number of days the injured or ill worker was:
K. Number of days the injured or ill worker was "On job transfer or restrictions"
L. Number of days the injured or ill worker was "Away from work"
M. Indicate an injury or, one type of illness:
(1) Injury column
(2) Skin disorder column
(3) Respiratory condition column
(4) Poisoning column
(5) Occupational hearing loss
(6) All other illnesses column
Page Totals (for columns (G)-(M))
Instruction: Transfer these totals to the Summary page (Cal/OSHA Form 300A) before you post it.
Instructions for privacy concerns:
"ATTENTION: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes."
Note: Privacy Concern Cases: employers using forms equivalent to the Cal/OSHA 300 (Rev. 4/2004) are required to follow the privacy concern disclosure restrictions specified in Section 14300.29(b)(6)-(10).
Note: Additional Criteria. Beginning January 1, 2002, employers are required to record the following as specific injury and illness conditions. These are:
1. Injury from a needle or other sharp object that is contaminated with blood or OPIM (Reference: Section 14300.8)
2. Cases of medical removal under the requirements of a Cal/OSHA standard. (Reference: Section 14300.9)
3. Tuberculosis infection as evidenced by a positive skin test or diagnosis by a physician. (Reference: Section 14300.11) Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code; and 29 Code of Federal Regulations Section 1904.10.
Appendix E - Required Elements for the Cal/OSHA Form 300A(Rev. 4/2004), Annual Summary of Work-Related Injuries and Illnesses Equivalent Form.
A. Employers who are required to complete the Cal/OSHA Form 300A (Rev. 4/2004) may use an equivalent form that provides all of the following information:
1. The number of cases:
(G) The total number of deaths
(H) The total number of cases with days away from work
(I) The total number of cases with job transfers or restriction
(J) The total number of other recordable cases
2. The number of days:
(K) The total number of days of job transfer or restriction
(L) The total number of days away from work
(M) Injury and Illness Types, the total numbers of:
1. Injuries
2. Skin disorders
3. Respiratory conditions
4. Poisonings
5. Hearing loss
6. All other illnesses
3. Posting requirement statement: "Post this Annual Summary from February 1 to April 30 of the year following the year covered by the form."
4. Establishment information:
w The establishment name
w Street address
w City, State, Zip
w Industry description
w The Standard Industry Classification Code, if known.
5. Employment information
w The annual average number of employees.
w The total hours worked by all employees last year.
(For assistance in calculating the annual average number of employees, and total hours worked, refer to Appendix G.)
6. Sign Here:
w Admonition: "Knowingly falsifying this statement may result in a fine."
w Certification statement: "I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete."
w Space for the signature of the company executive, and title.
w Phone number of signatory.
w Date of the certification. Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code; and 29 Code of Federal Regulations Section 1904.29.
Appendix F - Required Elements for the Cal/OSHA 301 Injury and Illness Incident Report Equivalent Form
I. An employer that is required to fill out a Cal/OSHA Form 301 may use an equivalent form that provides the following items of information:
A. Information about the employee:
1. Full name
2. Home street address, city, state and Zip code
3. Date of birth
4. Date hired
5. Employee gender
B. Information about the physician or other health care professional:
6. Name of the physician or other health care professional who treated the employee
7. Name and complete address of the facility where the employee received treatment (if applicable)
8. If the employee was treated in an emergency room (yes or no)
9. If the employee was hospitalized overnight as an in-patient (yes or no)
C. Information about the case:
10. The case number matching the Cal/OSHA Log 300 (or equivalent) entry
11. The date of the injury or illness
12. Time of employee began work AM/PM
13. Time of the event AM/PM; or indication that the time cannot be determined
14. Description of what the employee was doing just before the incident occurred
15. Description of what happened; how the injury/illness occurred
16. The specific injury/illness, part(s) of the body affected, and medical diagnosis if available
17. Identify the object or substance that directly harmed the employee
18. If the employee died, the date of death
D. The name of the person the form was completed by
E. The title of the person who completed the form
F. The phone number of the person who completed the form
Appendix G Worksheet to Help You Fill Out the Annual Summary
s 14301. Log and Summary of Occupational Injuries and Illnesses.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14303. Period Covered.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14304. Supplementary Record.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14305. Annual Summary.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14307. Retention of Records.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14308. Access to Records.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14309. Falsification, or Failure to Keep Records.
Note: Authority cited: Section 6410, Labor Code. Reference: Sections 6410, 6426 and 6431, Labor Code.
s 14310. Change of Ownership.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14311. Definitions.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14312. Petitions for Recordkeeping Exceptions.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14313. Employees Not in Fixed Establishments.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14314. Small Employers.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14315. Employers Covered by the Federal Mine Safety and Health Act.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14316. Private Sector Establishments Classified in Standard Industrial Classification Codes (SIC) 52-89, (except 52-55, 57, 70, 75, 76, 781, 79 and 80), in Accordance with the 1972 Edition of the "Standard Industrial Classification Manual," Incorporating the 1977 Supplement, Published by the Office of Management and Budget, Executive Office of the President.
Note: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14400. Statistical Surveys.
Note: Authority cited: Sections 6410 and 6411, Labor Code. Reference: Section 6411, Labor Code.
Note: Authority cited for Article 4 (Sections 14700-14710): Sections 6409 and 6410, Labor Code. Reference: Section 6410, Labor Code.
s 14900. Prison Labor.
Section 6413 (a) of the Labor Code requires that, except for the injuries specifically exempted by the section itself, injury reports shall be filed for every injury to any state prisoner (inmate) resulting from any labor performed by the prisoner (inmate). No reports need be filed if "disability resulting from such injury does not last through the day or does not require medical service other than ordinary first aid treatment."
Note: Authority cited: Section 6413, Labor Code.
s 14901. Department of Corrections' Report of Injury (Form 5030).
The report shall be submitted in duplicate (Form 5030), to the Division of Labor Statistics and Research on a standard form (Form 5030) approved by the Department of Corrections and the Division of Labor Statistics and Research, Department of Industrial Relations. The following information shall be included on the standard form:
Name, address and phone number of correctional institution;
Name, inmate number, sex, and date of birth of injured inmate;
Date of incarceration;
Type of labor (work) when injured and extent of total experience at that type of labor, and extent of prison training and safety training in that type of labor;
Extent of supervision over work methods used;
Where did the injury occur;
What was the object or substance that directly injured inmate;
Nature of injury and part of body affected;
What was the primary correctable cause of this accident;
What arrangements could be made to eliminate hazard;
Name of physician;
Date of injury;
Was injured unable to work on any day after injury;
Actual or estimated date of injured's recovery;
Date of death if injured died.
s 14902. Agreement Between Parties.
By agreement between the parties concerned Form 5030 may be modified as needs for pertinent information arise.
s 14903. Color of Form 5030.
The copy of the form to be used for transmission to the Division of Labor Statistics and Research must be printed on light blue stock.
s 14904. Time of Filing.
The report shall be filed within five days after the injury.
s 14910. Physician or Surgeon (Report Form 5031).
(a) Every physician or surgeon who attends, within a Department of Corrections institution, any injured inmate shall file with the Division of Labor Statistics and Research a complete report of such injury unless disability resulting from such injury does not last through the day or does not require medical service other than ordinary first aid treatment.
(b) The report shall be submitted in duplicate to the Division of Labor Statistics and Research on a standard form (Form 5031) approved by the Department of Corrections and the Division of Labor Statistics and Research, Department of Industrial Relations. Pertinent data required will include a statement as to the cause of the injury and the nature and extent of injury.
s 14911. Agreement Between Parties.
By agreement between the parties concerned Form 5031 may be modified as needs for pertinent information arise.
s 14912. Color of Form 5031.
The copy of the form to be used for transmission to the Division of Labor Statistics and Research must be printed on light blue stock.
s 14913. Time of Filing Form 5031.
The report shall be filed within five days after first treatment.
s 14920. Effective Date.
The California Department of Corrections shall commence submitting said reports on all injuries occurring January 1, 1975, and thereafter.
s 15000. Application.
Application for approval of charges shall be made in the form and manner prescribed by the Director of Industrial Relations, and shall be made not less than 30 days prior to the desired effective date. The application shall contain the following information:
(a) Date of transmittal to the director.
(b) A statement as to whether application is made by an association on behalf of its members, or by individual dealers.
(c) If made by individual dealers, their names and addresses.
(d) If made by an association:
(1) Name and address of association.
(2) Names and addresses of members of association.
(3) Names and addresses of any dealers operating in the market who are not association members.
(4) Function of association.
(e) Manner in which proposed charges have been established, i.e., by collective bargaining agreement or by dealers alone.
(1) If by collective bargaining agreement:
(A) A statement as to whether agreement is with association or with individual dealers.
(B) Whether or not all dealers in the market are parties to the agreement. If not, number of dealers who are covered.
(C) Name of union or unions, party to the agreement or agreements. (f) Period for which proposed charges are to be effective.
Note: Authority cited: Section 56832, Food and Agricultural Code. Reference: Sections 56956 and 56957, Food and Agricultural Code.
s 15001. Required Documents.
The following documents shall be transmitted with application:
(a) If application is made by an association, two copies of articles or agreement of association.
(b) If charges are established by collective bargaining agreement, two copies of such collective bargaining agreement.
(c) Schedule of proposed charges shall be submitted separately with application. Such schedule shall be in quadruplicate and in form for posting in accordance with Section 2 of the act. If more than one copy is required for posting, additional copies in sufficient number shall be submitted. Schedule must contain the following data:
(1) Heading which shall show:
(A) Name and location of market at which charges are applicable.
(B) Name of dealer association, or if no association, names of individual dealers on whose behalf schedule of charges is filed.
(C) Manner in which charges are established, that is, if by union agreement or if fixed by dealers alone.
1. If by union agreement, union or unions party to the agreement or agreements.
(2) Scale of proposed charges.
(3) The following statement shall appear at the foot of the schedule of charges: "The charges designated herein, when approved by the Director of Industrial Relations, shall be the standard rates to be charged for the unloading of farm produce at ________________________. It shall be Name of locality
unlawful to charge or receive any rates in excess of the charges established herein."
Note: Authority cited: Section 56832, Food and AgriculturalCode. Reference: Sections 56956 and 56957, Food and Agricultural Code.
s 15002. Approval.
(a) Any interested party may file with the director in formation relative to charges for similar work under similar conditions in or near the city in which the market is being operated, to be considered by the director in determining reasonableness of proposed charges.
(b) Upon approval, the director shall affix his approval stamp upon the schedule of charges and shall endorse such schedule with his signature.
(c) Two copies of said schedule shall be transmitted to the dealer or dealer association, one copy to be posted in a conspicuous place in the market where such charges are applicable, and one copy to be retained in the files of the dealer or the dealer association.
Note: Authority cited: Section 56832, Food and Agricultural Code. Reference: Section 56957, Food and Agricultural Code.
s 15003. Hearings.
(a) If the director finds any scale of charges or any item thereon to be unreasonable, he shall fix a time and place for a hearing on the matter.
(b) The director shall give notice by mail of such hearing to each produce dealer operating in the market for which such scale of charges has been filed, and to the officials of the union, if a union is involved. Notice shall also be given by mail to any producer of farm products delivered to the market who has made written request that he be so notified.
(c) Notice shall be mailed at least ten days in advance of the scheduled date of the hearing.
(d) At the conclusion of the hearing the director shall adjust the scale of any item thereof in accordance with Section 6 of the act.
(e) In the event the scale of charges is adjusted by the director in accordance with the provisions of this section, notice of such change shall be given by mail to all interested parties by the director.
Note: Authority cited: Section 56832, Food and Agricultural Code. Reference: Sections 56958 and 56959, Food and Agricultural Code.
s 15004. Proceedings After Adjustment of Scale of Charges.
In the event the scale of charges is adjusted by the director as provided for by Section 15003 of this article, new schedules of proposed charges as adjusted shall be filed with the director by the applicant as provided for in Section 15001(c) of this article.
Note: Authority cited: Section 56832, Food and Agricultural Code. Reference: Section 56952, Food and Agricultural Code.
s 15200. Authority.
Note: Authority cited; Sections 54, 55, and 3702.10, Labor Code. Reference: Sections 54, 55 and 3702.10, Labor Code.
s 15201. Definitions.
The following definitions apply in Articles 1 through 13 of these regulations:
(a) Adjusting Location. The office address designated in accordance with Section 15402 of these regulations where:
(1) The named administrator of the self insurer fulfills his/her function; and
(2) The original records called for in Article 9 of these regulations are maintained.
In the event that claims are administered at the home of a telecommuting adjuster, the location shall be considered as a separate adjusting location for reporting and audit purposes unless the telecommuting adjuster reports to a California location of the administrator no less than weekly.
(b) Administrative Director. The Administrative Director of the Division of Workers' Compensation within the Department of Industrial Relations.
(c) Administrative Agency. The person or firm that performs the day-to-day claims administration functions of a workers' compensation self insurance program. The administrative agency may be:
(1) An independent contractor possessing a certificate to administer and designated by a self-insurer to be the administrative agency for all or a portion of its claims; or
(2) A partnership or corporation possessing a master certificate to self insure, which administers its own claims and the claims of other affiliate or subsidiary self insurers issued affiliate or subsidiary certificates to self insure under the same master certificate number;
(3) A joint powers authority possessing a master certificate to self insure, which self administers in whole or part the claims of its affiliate public self insurers issued affiliate certificates to self insure under the same master certificate number of the joint powers authority; or
(4) The claims department of an insurance carrier admitted to transact workers' compensation insurance in California, which is exempt from the requirement to possess a certificate to administer under Labor Code Section 3702.1(a).
(d) Administrator. A competent person pursuant to Section 15452 of these regulations, at an adjusting location, who is responsible for day-to-day management of an employer's self-insurance workers' compensation program. The responsibility includes but is not limited to, the making and reviewing of decisions relating to the furnishing of all workers' compensation benefits in accordance with law and the maintenance of the self insurer's claim records.
(e) Affiliate Certificate.
(1) A type of certificate to self insure issued to a private self insurer that has common ownership to another private self insurer holding a master certificate to self insure, but the affiliated certificate holder is not a subsidiary to the master certificate holder; or
(2) A type of certificate to self insure issued to a public self insurer that is a member of a joint powers authority for pooling of workers' compensation liabilities with the master certificate number issued to the joint powers authority.
(3) A type of certificate to self insure issued to a private self insurer that is a member of a group self-insurance plan for pooling of workers' compensation liabilities with the master certificate number issued to the group self insurer.
(f) Alternative Composite Deposit. A security deposit system pursuant to Labor Code Section 3701.8 whereby all eligible private self insurers collectively secure, in whole or in part, aggregate self insured worker's compensation liabilities through the Self Insurer's Security Fund.
(g) Audit. Any examination of self insured workers' compensation claim files performed by or at the request of the Office of Self Insurance Plans pursuant to Labor Code Section 3702.6.
(h) Board of Trustees. In group self insurance, it is the representative body selected by the group member to be responsible for managing the assets and directing the affairs of the group self insurer corporation and assuring the group self insurer, through the group members, is financially sound and able to meet the workers' compensation liabilities under the statutes and regulations applicable in California.
(i) Cancellation of Surety Bond. An act whereby the surety gives written notice to the Manager, as beneficiary of the workers' compensation self insurance surety bond, that the surety is terminating its contractual obligations under the named bond pursuant to Sections 996.320 and 996.330 of the Code of Civil Procedure and the liability of the surety bond after the effective date of the cancellation is set forth in Section 996.360 of the Code of Civil Procedure.
(j) Certificate to Self Insure. A Certificate of Consent to Self-Insure issued to an employer pursuant to Section 3700(b) of the Labor Code.
(k) Certificate to Administer. A Certificate of Consent to Administer self insured workers' compensation claims issued to an administrative agency, except exempt insurance carriers, pursuant to Labor Code Section 3702.1.
(l) Claim File. A separate case file containing all pertinent documents and matters relating to a specific or companion work-injury claim. The claim file contents are specified in Section 15400 of these regulations.
(m) Claim Log. A manual or electronic listing of workers' compensation claims maintained by the self insurer or administrative agency for the self insurer. The claim log for private self insurers shall list each work injury claim by the calendar year in which the claim was reported to the employer or the claims administrator, whichever first occurred, and the claim log for public self insurers shall list each work injury claim by the fiscal year in which the claim was reported. The claim log contents are specified in Section 15400.1 of these regulations.
(n) Compensation. Compensation as defined in Labor Code Section 3207.
(o) Contribution. The amount of payments required of each group member in order to fund the compensation and deposit obligations of the group self insurer.
(p) Director. The Director of the Department of Industrial Relations.
(q) Exoneration of Surety Bond. The discharge of a surety from all past, present and future liability under its workers' compensation self insurance surety bond by the execution of a "Release of Surety", Form A4-24 (Rev. 11/92) by the Manager.
(r) First Aid. First Aid as defined in Labor Code Section 5401(a).
(s) Group Self Insurer. A private, non-profit, mutual benefit corporation pursuant to Part 3 (commencing with Section 7110) of Division 2 of Title 1 of the Corporation Code established for the sole purpose of operating a group workers' compensation self-insurance fund. Said self-insurance fund to pool California workers' compensation liabilities for two or more private employers in the same industry under the California workers' compensation statutes and regulations.
(t) Group Member. A private employer issued an Affiliate Certificate as a member in a group self-insurance program that has, in turn, been issued a Certificate to Self Insure as a group self insurer.
(u) Group Administrator. The individual authorized to serve as the representative of a group self insurer and its group members in carrying out the policies of the Board of Trustees of the Group Self Insurer and managing the activities of the group self insurer corporation.
(v) Indemnity Agreement and Power of Attorney. The written agreement executed by each group member or proposed group member of a group self insurer pursuant to Section 15479 of these regulations.
(w) Indemnity Claim. A work-injury case which has or may result in any of the following benefits:
(1) Temporary Disability or salary in lieu thereof
(2) Permanent Disability
(3) Life Pension
(4) Death Benefits
(5) Vocational Rehabilitation
(x) Industry. Employer classification as determined using the first two digits of the Standard Industrial Classification Code (SIC Code), provided by the Department of Commerce, Bureau of Management and Budget.
(y) Joint Powers Authority. A public entity created by agreement of two or more public agencies pursuant to Division 7, Chapter 5, Article 1, Sections 6500 et seq. of the Government Code. These regulations apply only to Joint Powers Authorities who have among their purposes for existence, the forming of workers' compensation liability pooling arrangements.
(z) Labor Code. The Labor Code of the State of California.
(aa) Manager. The Manager, Office of Self-Insurance Plans, in the Department of Industrial Relations.
(bb) Medical-Only Claim. A work-injury case which does not result in compensable lost time but results in medical treatment beyond first aid. Note:Payment of medical examinations pursuant to Labor Code Section 4600 will be considered a medical payment.
(cc) Open Claim. A work-injury case in which it appears that one or more future payments of workers' compensation benefits may be due.
(dd) Release of Surety Bond. Action of Manager of Self Insurance Plans by which a surety is exonerated. A released surety bond does not constitute part of the security deposit of a self insured entity.
(ee) Security Fund. The Self Insurer's Security Fund as established by Labor Code section 3742.
(ff) Self-Insurer. An individual public or private sector employer or joint powers authority or private group of employers that has been issued and lawfully holds a valid Certificate to Self-Insure its workers' compensation liabilities pursuant to:
(1) The provisions of Section 29(a), Chapter 586, Laws of 1917 and amendments thereto; and/or
(2) Labor Code, Section 3700(b) and 3700(c).
(gg) Special Audit. Any audit performed other than that in accordance with Labor Code Section 3702.6.
(hh) Subsidiary Certificate. A type of certificate to self insure issued to a subsidiary of a self-insurer, where the self insurer holds the master certificate to self insure.
(ii) Termination of Surety Bond. See definition of "Cancellation of Surety Bond".
(jj) Work-Injury Claim. An injury that is reported or reportable to the Division of Labor Statistics and Research pursuant to Labor Code Sections 6409, 6409.1 and 6413. (continued)