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Safe Practices for Construction Workplaces - Sample Code
The sample code in this form was developed by the California Department of Occupational Safety and Health. It is a suggested code, is general in nature and is intended as a basis for preparation of a code that fits the specific contractor's operations more exactly.
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Safety Inspection for General Work Areas and Offices Checklist
Personalize
Use this checklist to ensure that general work areas and offices are free of potential health or safety hazards.
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Safety Inspection for Work Spaces and Surfaces Checklist
Use this checklist to ensure that work spaces and surfaces are free of potential health or safety hazards.
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Safety Program Self Audit Checklist
Use this checklist to help ensure that your workplace safety program complies with state requirements and is well tailored to reducing risks and claims in your workplace.
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School and Child Care Activities Leave Checklist
Use this checklist to create and implement a school and child care activities leave policy for your company.
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Security and Violence Prevention
Use this form to identify and take preventive measures to increase security and minimize violence in the workplace. Acts of physical violence may arise from outside sources, such as burglars or customers, or from within, such as a disgruntled present or past employee.
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Serious Incident Report
Send this report to the nearest Cal/OSHA District Office within eight hours of a serious injury or death.
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Sexual Harassment Investigation Checklist
Review this checklist when conducting a harassment investigation for your company.
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Sexual Harassment Mandatory Training - Summary Training Record
Use this form to track ongoing company compliance with training required by California law.
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Sexual Harassment Training Certificate
Use this form to track sexual harassment training required for all employees under California law. Maintain in the file.
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State Disability Insurance and Paid Family Leave Benefit Amounts
Free
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State Disability Insurance Checklist
Use this checklist when your employee becomes disabled.
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Summary of Family, Medical and Pregnancy Disability Leave Laws
This form summarizes employer obligations as provided in federal and state family and medical leave laws (FMLA/CFRA) and the California Pregnancy Disability Leave law. It also shows the relationship between these laws and benefits available to employees while taking these leaves.
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Telecommuting Agreement
Personalize
Use this form once a telecommuting relationship has been approved to describe the expectations your company has of employees who telecommute.
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Telecommuting Request
Provide this form to employees who request to telecommute. This form will help you understand why they wish to telecommute and whether such accommodation is appropriate.
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Telecommuting Request Checklist
This checklist should be completed after receiving a request for telecommuting plan to evaluate whether telecommuting is appropriate for the individual and the job an employee performs.
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Telecommuting Safety Checklist
Use this form in conjunction with your company's safety checklist for your workplace to ensure the telecommuter's workspace is safe.
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Temporary Modified Duty Agreement
Use this form to document a temporary, modified duty assignment.
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Termination Checklist
Use this checklist when terminating an employee to ensure that you have completed all legally required forms.
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Termination Decision Checklist
Updated
Use this checklist to help evaluate whether termination of an employee is likely to lead to litigation. This checklist helps to avoid potential legal problems by suggesting issues to review with counsel before terminating the employee.
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Unemployment Insurance - Responding to a Claim Checklist
Review this checklist for suggested actions on how to handle a claim for unemployment insurance.
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Unemployment Insurance Benefit Table
Review this chart to determine the employee’s quarterly wage during the employment base period and the corresponding weekly benefit amount.
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Unemployment Insurance Benefit Table - Spanish
Review this chart to determine the employee’s quarterly wage during the employment base period and the corresponding weekly benefit amount.
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Unprofessional Behavior and Sexual Harassment
Use this form to learn more about certain behavior that may qualify as sexual harassment.
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VETS-4212
Free
Certain federal contractors must file a VETS-4212 form. Reports must be filed between August 1 and September 30. The report is required on an annual basis.
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Victims of Crime Leave Checklist
Use this checklist to create and implement a crime victims' leave policy for your company.
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Voluntary Self-Identification of Disability
Free
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Volunteer Civil Service Leave Checklist
Use this form to create and implement a volunteer civil service leave policy for your company.
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W-4 — Employee's Withholding Certificate
Free
Use this required W-4 form to obtain information from an employee to determine the correct Federal income tax amount to withhold from his/her paychecks.
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W-4 — Employee's Withholding Certificate — Spanish
Free
Use this required W-4 form to obtain information from an employee to determine the correct Federal income tax amount to withhold from his/her paychecks.
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Wage and Employment Notice to Employees (Labor Code section 2810.5)
Free
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Wage and Employment Notice to Employees (Labor Code section 2810.5) - Spanish
Free
Provide this form to all nonexempt employees at the time of hire. If any change is made to the information on this form, notify employees of the change in writing within seven calendar days after the time a change was made.
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Wage Order 01 - Manufacturing
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Wage Order 02 - Personal Services
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Wage Order 03 - Canning Freezing and Preserving
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Wage Order 04 - Professional Technical Clerical Mechanical and Similar Occupations
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Wage Order 05 - Public Housekeeping
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Wage Order 06 - Laundry Linen Supply Dry Cleaning and Dyeing
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Wage Order 07 - Mercantile
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Wage Order 08 - Industries Handling Products After Harvest
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Wage Order 09 - Transportation
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Wage Order 10 - Amusement and Recreation
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Wage Order 11 - Broadcasting
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Wage Order 12 - Motion Picture Industry
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Wage Order 13 - Industries Preparing Agricultural Products for Market, on the Farm
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Wage Order 14 - Agricultural Occupations
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Wage Order 15 - Household Occupations
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Wage Order 16 - On-site Construction Drilling Logging and Mining
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Wage Order 17 - Miscellaneous Employees
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Wage Orders - Business Occupation Listing
Free
This chart lists businesses and occupations, and their corresponding Wage Orders.
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WARN Notice - Employees
Personalize
Use this form to notify employees of plant closures or mass layoffs in accordance with the WARN Act.
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WARN Notice - State and Local Officials
Use this form to notify state and local officials of plant closures or mass layoffs in accordance with the WARN Act.
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WARN Notice - Union Representatives
Personalize
Use this form to notify union representatives of plant closures or mass layoffs in accordance with the WARN Act.
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Warning Letter Checklist and Sample
This letter is an example of a warning letter given for a particular situation with respect to performance and conduct. It is NOT meant for you to print out and deliver to an employee. Rather, you are to review this letter and use the examples as a guide for how to draft your own letter of warning.
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Work Surfaces and Work Space Safety
Specific Cal/OSHA standards govern workplace conditions and structures. Use this form to help you identify and meet these standards.
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Worker Training and Instruction Record
Personalize
Use this form to document and track all training provided to an employee.
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Workers' Compensation Benefits for Victims of Workplace Violence
Personalize
Use this sample notice when an employee is a victim of a crime at your workplace. You must give the employee written notification of his or her eligibility for workers' compensation benefits for resulting injuries, including psychiatric injuries.
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Workers' Compensation Checklist
Complete this checklist to fulfill your obligations regarding workers' compensation.
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Workers' Compensation Claim Form - DWC 1
Free
If an employee suffers a work-related injury or illness, he or she may be entitled to workers' compensation benefits. Give this form to the employee and have them complete the "Employee" section and then return the form to you. Give the employee the copy marked "Employee's Temporary Receipt," providing the employee with a dated copy when you have completed the form. All employees should also have received a pamphlet describing workers' compensation benefits and procedures to obtain them.
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Workers' Compensation Claim Form - DWC 1 - Spanish
Free
If an employee suffers a work-related injury or illness, he or she may be entitled to workers' compensation benefits. Give this form to the employee and have them complete the "Employee" section and then return the form to you. Give the employee the copy marked "Employee's Temporary Receipt," providing the employee with a dated copy when you have completed the form. All employees should also have received a pamphlet describing workers' compensation benefits and procedures to obtain them. This form has been made available by the Department of Industrial Relations for use with non-English speaking employees.
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Workers' Compensation Information and Assistance Offices
Free
Contact addresses and phone numbers for local DWC Information and Assistance Units. The I & A Unit provides information and assistance to employees, employers, insurance carriers and other interested parties concerning rights, benefits and obligations under California's workers' compensation laws.
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Workplace Harassment Guide for California Employers
Free
This Department of Fair Employment and Housing publication provides recommended employer practices for preventing and addressing all forms of workplace harassment, including harassment based on sex.
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Workplace Safety Recordkeeping Requirements - CalOSHA
Use this form to help you identify the records you must make and keep under various Cal/OSHA standards.
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Workplace Security Profile
Fill out this Cal/OSHA form in order to assess the risk of violence in a particular workplace.
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Workplace Violence Factors and Control Checklist — OSHA
Free
This checklist can help employers identify present or potential workplace violence problems. This checklist was created for late-night retail establishments and contains various factors and controls commonly encountered in that setting. Not all of the questions listed here fit all types of retail businesses, and this checklist does not include all possible topics specific businesses need. Employers should expand, modify and adapt this checklist to fit their own circumstances.
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Workplace Violence Incident Report Form
Make this form available to all employees to use when they believe an incident of workplace violence has occurred. Any employee who experiences an incident s/he believes to be threatening or violent should complete this incident report form; and all supervisors should be trained regarding its use. Supervisors should be trained that upon completion of the incident report form, they are to immediately forward the form to the Crisis Management Team, or whatever person or group is responsible in your company for responding to workplace violence concerns. The completion of this form is what launches an investigation.
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Workplace Violence Incident Report Form 1 — OSHA
Free
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Workplace Violence Incident Report Form 2 — OSHA
Free
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Workplace Violence Inspection Checklist — OSHA
Free
This checklist can help employers identify present or potential workplace violence problems. This checklist was created for late-night retail establishments and contains various factors and controls commonly encountered in that setting. Not all of the questions listed here fit all types of retail businesses, and this checklist does not include all possible topics specific businesses need. Employers should expand, modify and adapt this checklist to fit their own circumstances.
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Work-Related Injuries and Illnesses Log - Form 300
Free
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, medical treatment beyond first aid, that are diagnosed by a physician or licensed health care professional, or meet any criteria listed in CCR Title 8 sec. 14300.8 through 14300.12. 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, call your local Cal/OSHA office for help.
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Work-Related Injuries and Illnesses Summary- Form 300A
Free
All establishments covered by 8 CCR sec. 14300 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the log to verify that the entries are complete and accurate before completing this summary. Post this Summary page from February 1 to April 30 of the year following the year covered by the form.
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Worksite Ergonomics Evaluation Form
Use this form to evaluate if employee workspaces meet ergonomic standards.
