DWC-1 — Wesley Grant
Client Admin ▸ Safety ▸ Claims ▸ Claim form ▸ Case 1 · 2026 · Amarillo Yard
This workflow records dates and surfaces the duties that attach to them. It does not decide, accept or deny a claim, does not authorise treatment, and does not file anything on your behalf. It is not legal advice — confirm your obligations with counsel or your claims administrator.
Records the moment the form was provided to the employee, which is the evidence for the one-working-day duty. This employee has no email address on file, so there would be nowhere to send it — give them the link or a printed copy directly.
Employee section — completed and signed by the employee — read-only here
Employer section — completed and signed by the employer
Date of knowledge — the one date both statutory windows below are measured from
Date the employer first knew
2026-09-10
Both windows on this form are measured from it — Labor Code 5401(a) and 5402(b).
Entered by hand. This claim has no field incident report behind it — the case was recorded directly, which is the ordinary path for a walk-in injury reported straight to HR.
Where the clocks stand — 1 window needing attention
- Give the employee the claim formOverdue41 working days elapsed, target 1
- Employee returns the completed formnot startedinternal target
- Forward a dated copy to the carrier and the employeenot started
Working days are counted Monday to Friday. Public holidays are not subtracted — California’s list changes and employers observe different ones, so a wrong calendar would silently move a statutory deadline. Counting only weekends errs tight, never loose. The employee-return window is an internal follow-up target of 10 days, not a legal deadline; the two one-working-day windows are statutory.
Timeline — every step, with who and when — append-only
- Form startedDraft18 Sep 2026 · 05:09 UTCEHM super-admin on behalf of Acme Manufacturing · date of knowledge 2026-09-10
Read from the audit log rather than from the form’s own columns: the columns hold the current value of each stamp, the log holds what actually happened, in order, and cannot be edited or deleted by anyone.
Every step is recorded with who did it and when · the form is retained, never deleted