DWC-1 Form Download: How to File a Work Injury Reporting Form in California

November 3, 2025

Table of Contents

Estimated reading time: 18–22 minutes

Published: November 3, 2025 — Last reviewed: November 3, 2025

Key Takeaways

The DWC‑1 form download is the official California work injury reporting form that starts a workers’ compensation claim and creates a formal record.
File as soon as possible—generally within 30 days of the injury or when you realize it’s work‑related; verify current rules on the California Division of Workers’ Compensation site.
Employers must provide a DWC‑1 within one working day of learning about an injury and return a completed copy promptly; confirm exact wording on the DWC website.
You can submit the DWC‑1 via paper, employer HR portals, insurer portals, or email/secure upload; keep proof (receipts, confirmation numbers, timestamped emails).
Use our step‑by‑step, field‑by‑field guide to avoid common errors like vague descriptions, missing dates, or unlisted body parts.
If issues arise (delays, denials, retaliation), document everything and consult official DWC resources and, where needed, a workers’ comp specialist.

If you’ve been injured at work in California, your first step is the DWC-1 form download — the official work injury reporting form California requires to begin a workers’ compensation claim. This guide includes a direct DWC‑1 form download link, printable sample completed DWC‑1, step‑by‑step instructions on how to complete workers comp paperwork, and options for reporting workplace injury online.

Download DWC‑1 Form (PDF) | Download Sample Completed DWC‑1 (PDF) | Printable DWC‑1 Submission Checklist (PDF)

If you need immediate medical care call 911 or your employer’s designated medical provider.

What is the DWC‑1 (California Workers’ Compensation Claim Form)?

The DWC‑1 (Division of Workers’ Compensation Claim Form) is the official California form used to notify an employer and their insurer of a work‑related injury or illness and to start your workers’ compensation claim. The California Division of Workers’ Compensation (DWC) administers the state system and provides the official forms and guidance.

The DWC‑1 is the state’s initial injury report form and is distinct from any employer internal incident report; the DWC‑1 creates a formal record that can trigger benefits. Example: Filing a DWC‑1 after a slip‑and‑fall notifies your employer and starts the process for medical care and disability benefits.

Because rules and interpretations can change, always verify details on the California DWC website.

Related reading: a broader walkthrough of filing in California is covered in How to File a Workers’ Comp Claim in California and in our guide to workers’ compensation benefits.

When and Why You Must File a DWC‑1

Timelines (verify on the DWC site):

File as soon as possible—and generally within 30 days of the injury or the date you first realize the condition is work‑related (for cumulative injuries). Always confirm current deadlines at the DWC site.
Employer obligations: Employers must provide the DWC‑1 to an injured worker within one working day of learning about the injury, and return a completed copy to the employee promptly (confirm exact wording and timing on the DWC site).

Why it matters: Missing timelines can delay benefits, create gaps in medical coverage, and may risk denial of certain benefits. California’s timing rules are strict; learn how timeline rules interact with claim investigations in our overview of the workers’ compensation 90-day rule.

Employee checklist:

Report the injury to your supervisor immediately.
Request the DWC‑1; if it’s not provided, use the official DWC‑1 form download.
Complete the employee sections, sign, and return to the employer; keep a copy.
Document how/when you submitted (email, portal upload, in-person handoff).
Save everything—emails, messages, photos, and receipts.

Employer checklist:

Provide a DWC‑1 within one working day of notice of injury.
Complete the employer portion and forward to the insurer/administrator.
Return a completed copy to the employee and maintain internal records.

Legal‑readiness note: Always verify these timelines on the official California DWC website because rules and interpretations can change.

DWC‑1 Form Download: Official PDFs and Accessibility

Use the official, current versions provided by California’s DWC. If your employer gives you a different copy, compare it to the latest DWC version to ensure consistency.

Official English PDF:Download the DWC‑1 (English)
Official Spanish PDF:Descargar DWC‑1 (Español)
Annotated/sample completed form (mirror):View an annotated sample DWC‑1
All DWC forms: See the DWC Forms page for updates.

Accessibility notes:

Provide the Spanish link prominently when sharing with Spanish‑speaking coworkers.
If PDFs are not fillable, you can print, hand‑write, or use a PDF editor (Adobe Reader, Preview) to add text and a signature.
No printer? Save the signed PDF (e-sign if permitted) and email or securely upload it—ask your employer or insurer for their preferred channel.
Include clear alt descriptions when linking to downloads for screen reader users (e.g., “Download the official California DWC‑1 claim form, PDF”).

Pro tip: When saving files, use a clear, consistent naming format such as Lastname_Firstname_DWC1.pdf.

Step‑by‑Step: How to Complete Workers Comp Paperwork (DWC‑1 Field‑by‑Field Guide)

Use this field‑by‑field checklist to complete your initial injury report form accurately. Keep your statements short, factual, and specific.

Employee name

Enter your full legal name as it appears on payroll records. Example: Jane M. Doe. Avoid: nicknames or shortened names if payroll uses a different legal name.

Home address

Provide your current mailing address: street, city, state, ZIP. Example: 123 Oak St., Los Angeles, CA 90012. Avoid: outdated addresses that could delay notices.

Date of birth

If requested on the form, use MM/DD/YYYY. Example: 02/14/1986. Avoid: ambiguous formats (e.g., 2/14/86 vs 02/14/1986).

Date of injury

Enter the specific date the injury occurred—or the date you first noticed a work‑related condition. For cumulative trauma (repetitive strain), provide both the first date of injury and the date you first became aware it was work‑related. Avoid: leaving cumulative injury details vague.

Time of injury

Enter the approximate time. If unknown, write “unknown” rather than leaving it blank. Avoid: inconsistent time entries between this form and any incident reports.

Address where injury occurred

Provide the job site address or precise location description. Example: Loading Dock B, 400 Industrial Way, Oakland, CA. Avoid: general entries like “warehouse” if a more precise location is available.

Describe injury/illness

Use a clear, specific sentence that ties the task, mechanism, and result.

Template: “While [job task], I [mechanism] resulting in [injury/affected body part].”
Examples:
- Slip/fall: “While lifting boxes of tile, I slipped on a wet floor and twisted my right ankle, causing pain and swelling in the right ankle.”
- Repetitive strain: “While keyboarding 7–8 hours per day, I developed numbness and pain in my right wrist and forearm consistent with repetitive strain.”
- Chemical exposure: “While cleaning equipment with solvent, I inhaled fumes and developed chest tightness, coughing, and eye irritation.”

Avoid: vague phrases like “hurt back” or “work injury” with no mechanism or body part detail.

Body parts affected

List all affected areas. Be specific: include side (left/right), region, and any radiating pain. Example: lumbar spine (L4–L5), right wrist. Avoid: leaving out minor aches; include everything that hurts now.

Witnesses

List names, phone numbers, and a brief note of what they saw or heard. Avoid: “unknown” when you can identify supervisors or coworkers who heard or saw the event.

Treating physician/medical treatment

Enter facility and date of first treatment. If emergency care, note: “ER — [Hospital Name] — [Date]”. If you were directed to an employer medical provider, note the clinic name. Avoid: leaving blank if you’ve already been seen.

Supervisor/Employer name & address

Use the exact company name on payroll and your immediate supervisor’s name and work address. Avoid: abbreviations that differ from payroll records.

Signature and date

Sign with your legal name; date in MM/DD/YYYY. If you cannot sign due to injury, explain and attach a medical note if available. Avoid: omitting the date; it helps document timeliness.

Additional fields

If the form asks about lost time, check the applicable box and list your first missed day and estimated return date if known. Avoid: guessing—if unsure, write “unknown” or “pending medical evaluation.”

Annotated sample: For a visual reference, see this annotated sample completed DWC‑1. (If screenshots are used in an internal resource, ensure they include numbered callouts and concise alt text.)

Common mistakes (and fixes):

Vague descriptions → Replace with concise, specific mechanisms and body parts (e.g., “lumbar strain after slip on wet floor on 05/01/2025”).
Missing dates/time → Complete them or write “unknown.”
Not listing all body parts → Include every area that hurts now; you can update later if new areas emerge.
Unsigned forms → Sign and date; keep a signed copy for your records.
Cumulative injuries → Don’t list only the last date; explain the exposure period and date of awareness.

Copy‑and‑paste description templates:

Slip/fall: “While carrying a 25‑lb box across the warehouse, I slipped on a wet floor and fell onto my right side, resulting in right hip and lower back pain.”
Repetitive strain: “Due to continuous assembly line work requiring repetitive gripping and rotation, I developed pain and numbness in my left forearm and wrist over the past six months.”
Chemical exposure: “While cleaning the parts washer with solvent for 30 minutes in a poorly ventilated area, I inhaled fumes and developed dizziness, coughing, and burning eyes.”

Keep a copy. It’s best practice to keep a personal copy of every document you submit, including your completed DWC‑1.

For broader filing steps that follow after the DWC‑1, see our guide to applying for workers’ comp in California.

Initial Injury Report Form (DWC‑1) vs Employer Incident Report — What’s the Difference?

DWC‑1 (Claim Form): This is the legal claim form that can trigger benefits and is used to notify your employer and the insurer of a work injury or illness. It helps establish the formal record required for workers’ compensation administration under California’s system (administered by the DWC).

Employer Incident Report: This is an internal document for the employer’s safety, HR, or OSHA reporting processes. It does not substitute for a DWC‑1 and, by itself, may not trigger your benefits.

Practical steps:

Complete the DWC‑1 and give it to your employer; ask for a completed copy back and keep your own copy.
Complete any employer incident report if requested—but do not rely on it to start benefits.

Reminder: An employer’s internal report does not substitute for filing a DWC‑1; always ensure a DWC‑1 is completed.

Need more context on the claim workflow? See our plain‑English explainer on how to file a workers’ comp claim.

Reporting Workplace Injury Online — Employer & Insurer Options

You may be able to submit your form or claim information electronically, depending on your employer or insurer.

Common channels:

Employer HR/self‑service portals (e.g., Workday, ADP, BambooHR): Upload your signed DWC‑1 and complete any prompts.
Insurer online intake portals: Many carriers accept claim intake details and document uploads online.
Email/secure upload to claims administrator: Ask for the designated email or secure link. Include your signed DWC‑1 and any supporting documents.
DWC information resources: Use the California DWC site and DWC forms page to locate official guidance and forms.

Step‑by‑step online submission flow:

Create or log in to your account (use your legal name; if required, verify with employer/insurer code).
Enter basic incident details (copy key facts from your paper DWC‑1 to keep wording consistent).
Upload your signed DWC‑1 PDF (recommended filename: Lastname_Firstname_DWC1.pdf).
Submit and capture confirmation (screenshot or copy the confirmation number).
Save records (download confirmation emails and store a copy of your PDF to personal email or a secure drive).

Screenshot guidance: If you’re compiling internal job aids, include 3–4 example screenshots (account creation → upload → confirmation) with alt text such as “Screenshot — upload DWC‑1 in insurer portal.”

What to expect after submitting online:

You should receive a confirmation number or email from the portal or insurer.
A claims adjuster typically reaches out within several business days to gather additional information.
Some initial medical treatment may be authorized while the claim is investigated—verify exact rules and thresholds on the DWC site.

Sample email subject line for emailed submissions: “DWC‑1 Submission — [Employee Name] — [Date of Injury]”.

For a deeper dive into reporting rules and next steps, review filing a claim in California and what to do if you run into denied benefit issues.

After You Submit: What Happens Next and How to Track Your Claim

Employer acknowledgment & insurer assignment: Your employer should return a completed copy of the DWC‑1 to you after finishing their section, and the insurer opens a claim file and assigns an adjuster. Confirm procedures on the DWC forms page and main DWC site.

Medical care: If emergent, seek ER care (call 911). Otherwise, follow employer/provider network instructions. Some treatment may be authorized while the claim is investigated; verify current rules on the DWC site. For an overview of what medical benefits can include, see our guide to medical coverage in workers’ comp.

Temporary disability (TD)/pay: If you miss work due to your injury, you may be eligible for wage replacement (TD). Amounts and timing depend on state rules; verify specifics with DWC resources and discuss with your adjuster. Our benefits overview explains the main categories.

Claim acceptance/denial: The insurer investigates and will notify you in writing of acceptance or denial. If denied, the letter should explain reasons and next steps for dispute. You can appeal; learn how the process works in our resource on appealing denied benefits.

Tracking tips (create a simple claim log):

Keep both paper and digital folders for all forms, dates, and contacts.
Save confirmation emails; take screenshots of online submissions.
Log all medical visits and any work restrictions in one place.
Record phone calls (date, name, summary); follow up calls with a short email recap.

When to involve a lawyer: Consider a consultation if your claim is denied, benefits are delayed, you experience potential retaliation, or your injuries are complex (e.g., multiple body parts, surgery, second opinions). If you haven’t heard from an adjuster within 7–14 business days or your TD benefits are refused without explanation, consider getting guidance. For medical‑legal disputes (e.g., about your permanent disability rating), learn how a Qualified Medical Evaluator (QME) works in California claims.

Emergency reminder: If you need immediate medical care, call 911 or your employer’s designated medical provider.

Templates, Downloads & Tools — Ready to Use

Official DWC‑1 form (English):Download the DWC‑1 claim form (PDF) — official state form.
Official DWC‑1 form (Spanish):Descargar formulario oficial DWC‑1 (PDF).
Sample completed DWC‑1 (annotated):See an annotated sample (PDF).
Printable DWC‑1 submission checklist (PDF): Print this list and attach it to your folder.
- Report injury to supervisor (note date/time).
- Download and complete DWC‑1 (save a signed copy).
- Take photos of the scene/injury (if safe and permitted).
- Collect witness names and contact info.
- Submit DWC‑1 to employer (note method & date).
- Save confirmation or receipt (email, portal confirmation, or date‑stamped screenshot).
- Seek medical care and keep all records.
Employer incident report template (create): Capture date/time, exact location, detailed mechanism, equipment involved, witnesses, initial symptoms, and supervisor notified (name/date/time). Include a signature block for you and the supervisor.
Email template to notify employer/insurer:
- Subject: DWC‑1 Submission — [Your Name] — [Date of Injury]
- Body: “Hello [Name], I’m submitting my completed DWC‑1 for my work‑related injury on [Date]. Summary: [one sentence mechanism/body parts]. Attached: DWC‑1 (signed). Please confirm receipt and advise on the next steps for treatment and claim processing. Thank you.”
What to say (phone/in‑person script): “I’m reporting a work‑related injury from [date/time] at [location]. I was [task], then [mechanism], and now have pain in [specific body parts]. I need the DWC‑1 claim form and instructions for medical treatment. How should I submit the form to you?”

Recommended filenames & labeling:Lastname_Firstname_DWC1.pdf, Lastname_Firstname_IncidentPhotos_YYYYMMDD.zip, Lastname_Firstname_MedicalNotes_YYYYMMDD.pdf. Clearly label documents to speed up claim handling.

CTA links for quick access:Download DWC‑1 Form Now and Download Sample Completed Form & Checklist.

Troubleshooting & Common Mistakes — What to Do If Something Goes Wrong

Scenario: Lost form or no printer. Re‑download the official form from the DWC‑1 link, fill it digitally (PDF editor), sign, and email to your employer with a read‑receipt request (or submit via any official portal).

Scenario: Need to correct errors after submission. Notify your employer and insurer in writing (email is fine). Submit an amended DWC‑1 (if requested) and explain the correction; date and sign your note.

Scenario: No confirmation of submission. Call employer HR and the insurer; ask for written acknowledgment. If you used a portal, capture a screenshot of the confirmation page and save the confirmation email.

Scenario: Employer retaliation concerns. Document incidents (dates, names, what happened). Use official resources—start at the DWC site—and consider consulting a workers’ comp specialist. California protects injured workers from retaliation; learn more about your protections and response options in our guidance on retaliation after filing.

Proof‑of‑submission you can request/retain: Signed receipt from HR, claim confirmation number, timestamped email acknowledgment, portal upload screenshot.

Copy‑and‑paste email subject line + one‑sentence request:Subject: DWC‑1 Submission — [Your Name] — [Date of Injury]. Body (first line): “Please confirm receipt of my DWC‑1 and advise on medical treatment authorization and next steps.”

Need help figuring out next steps if your claim stalls? See our practical checklist for when an adjuster is not responding and what to do if your claim is denied.

Sources & Official California DWC Resources

Important: Verify current rules, filing timelines, and forms on the official California DWC website. Laws and procedures can change. For general, step‑by‑step education on how to complete workers comp paperwork, also see our guides on medical‑legal evaluations (QME) and filing a California claim.

Conclusion

Filing your DWC‑1 promptly preserves your rights, creates the record you need to access care and benefits, and keeps your claim on track. Use the official DWC‑1 form download, follow the field‑by‑field guidance above on how to complete workers comp paperwork, and submit it to your employer with proof. Keep copies, track confirmations, and verify timelines and processes at the California DWC website. If any part of the process becomes confusing or stalls, document everything and seek help early. Start your claim now: download the official DWC‑1 form, complete the fields using our step‑by‑step guide, and submit it to your employer. If you have questions, verify procedures at the California DWC: https://www.dir.ca.gov/dwc/.

Need help now? Get a free and instant case evaluation by Visionary Law Group. See if your case qualifies within 30-seconds at https://eval.visionarylawgroup.com/work-comp.

FAQ

How quickly should I file a DWC‑1?

File as soon as possible and generally within 30 days of the injury—or when you first realize it’s work‑related for cumulative injuries. Because deadlines can change, verify the most current rules on the California DWC site. If your employer doesn’t provide the form promptly, use the official DWC‑1 form download.

Can I submit a DWC‑1 online?

Often, yes. Many employers or insurers accept reporting workplace injury online through portals or email/secure upload. Follow the steps above: create an account if needed, upload your signed PDF, and save the confirmation number or email. Keep the original DWC‑1 for your records and verify any portal requirements on your employer’s or insurer’s site.

What if my employer refuses to give me the DWC‑1?

You can download the official form directly from the state: official DWC‑1 claim form. Complete and submit it to your employer and keep proof of submission (email confirmation, portal upload screenshot, or dated receipt).

Do I need an attorney right away?

Not usually. Many claims proceed without one. Consider consulting a specialist if the claim is denied, benefits are delayed, retaliation is suspected, or injuries are complex. First, document timelines and communications and review our step‑by‑step guides to appeal a denial and navigate medical‑legal evaluations (QME) to understand your options.

What’s the difference between the initial injury report form and my employer’s incident report?

The DWC‑1 is the initial injury report form for the state and can trigger benefits; the employer incident report is an internal document for safety/HR purposes and does not replace the DWC‑1. Always complete and submit the official DWC‑1 claim form to create your formal record.

DWC-1 Form Download: How to File a Work Injury Reporting Form in California