Notice of Employee Death to the Department of Industrial Relations

In addition to the Cal/OSHA required notice of serious injury or illness or death and required Form 5020 - Employer’s Report of Occupational Injury or Illness, every employer shall notify the Administrative Director of the Department of Industrial Relations of the death of any employee regardless of the cause of death by use of DIA 510 - Notice of Employee Death.¹

This form is required to be filed with the Administrative Director within 60 days of your knowledge of the death of any employee, unless you have actual knowledge that the employee left a surviving minor child under the age of 18, in which case you are not required to