Employers use Form SH-3 to document any safety incidents or accidents that occurred and the action taken as the result of an accident.
Preview / Forms
The Personnel Advisor library contains over 100 human resource forms, checklists, and policies. Our interactive forms are designed to assist employers and HR professionals in the productive and prudent use of human resources. They save time by reducing the administrative workload and help employers avoid personnel problems and legal compliance issues.
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Note: Mandatory written notices that must be distributed to employees are located in the Posters section under "Mandatory written notices."
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ACCIDENT INVESTIGATION REPORT
AFFIDAVIT TO COLLECT COMPENSATION OF DECEASED EMPLOYEE
Form to be completed by surviving spouse, registered domestic partner, guardian or conservator of the estate in order to obtain deceased employee's wages, up to $5,000.
AFFIRMATIVE ACTION PLAN MODEL
Form EO-2 can be used to document Affirmative Action analysis.
APPLICATION FOR EMPLOYMENT
Application for Employment (Form S-4) may be used to obtain information from prospective job applicants. The form has been updated to reflect recent changes to the law regarding criminal history and salary history.
ATTENDANCE LOG
Use the Attendance Log Form to track employee attendance for an entire year. Record vacation, sick days, family leave and other absences.
CAL/OSHA FORMS
Employer Records of Occupational Injuries and Illnesses*
The following links provide the required occupational injury and illness forms for employers covered by Cal/OSHA.
Exempt employers (those not subject to record keeping requirements): Employers with 10 or fewer employees are normally exempt from Cal/OSHA injury and illness recordkeeping and posting requirements. In addition, employers with 11 or more employees, whose businesses are in certain exempt industries, are not required to keep Cal/OSHA records or post annual summaries. A complete list of exempt industries in the retail, services, finance, insurance, and real estate sectors is available from Cal/OSHA (see "Table 1" on the Cal/OSHA Web page).
Note: even if a particular industry is exempt from the recordkeeping portion of the OSHA regulations, it does not mean the industry is exempt from Cal/OSHA's overall safety requirements. All employers, including those partially exempted by reason of company size or industry classification, must report to the Division of Occupational Safety and Health any workplace incident that results in a serious injury or illness, or death.
Appendix A - Cal/OSHA Form 300 Log of Work-Related Injuries and Illnesses
Appendix B - Cal/OSHA Form 300A Summary of Work-Related Injuries and Illnesses
Appendix C - Cal/OSHA Form 301A Injury and Illness Incident Report
Appendix D - Instructions to Complete Cal/OSHA Form 300
Appendix E - Instructions to Complete Cal/OSHA Form 300A
Appendix F - Instructions to Complete Cal/OSHA Form 301
Appendix G - Worksheet to Help Employers Fill Out the Annual Summary
CALIFORNIA FAMILY RIGHTS ACT (CFRA) CERTIFICATION FORM
CFRA Certification of Health Care Provider Form (DFEH-E11P-ENG)
CALIFORNIA PERSONAL INCOME TAX (PIT) WITHHOLDING
Form DE 4, is for California Personal Income Tax (PIT) withholding purposes only. The DE 4 is used to compute the amount of taxes to be withheld from an employee’s wages. Beginning January 1, 2020, the federal Employee’s Withholding Allowance Certificate (Form W-4), from the Internal Revenue Service (IRS), will be used for federal income tax withholding ONLY. Employees must file the state Form DE 4 to determine the appropriate California Personal Income Tax (PIT) withholding.
California Personal Income Tax Withholding - Form DE 4 (1/2021)
California Personal Income Tax Withholding - Form DE 4 - Spanish (1/2021)
CHANGE IN RELATIONSHIP NOTIFICATION FORM
Employers must provide written notice to employees immediately upon their discharge, layoff, leave of absence, or change in employment status.
CHECKLIST FOR BARRIERS FOR DISABLED WORKERS
Use Form EO-1 to assess workplace compliance with accessibility design standards to accommodate persons with disabilities.
CHECKLIST FOR NEW EMPLOYEES
Form S-7 (Orientation of new employees) is a check list of topics that should be covered with the new employee during his/her first week of employment.
CHILDREN'S HEALTH INSURANCE PROGRAM NOTICE
Employers that live in states that offer premium assistance under state Medicaid or the Children’s Health Insurance Program (CHIP) must provide a model notice to inform employees of potential opportunities available for premium assistance. The notice is required under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), and must be provided annually to employees on the first day of each plan year.
CHIPRA Notice: English (expires 1-31-2023)
CHIPRA Notice: Spanish (expires 1-31-2023)
COBRA MODEL FORMS (FEDERAL COBRA)
The sample COBRA forms are based on model forms provided by the U.S. Department of Labor. Certain provisions might not be appropriate for a given company's health plan. Employers should take care to conform it to the particulars of their plan (s).
Model COBRA General Notice: English (expires 1-31-2023)
Model COBRA General Notice: Spanish (expires 1-31-2023)
Model COBRA Election Notice: English (expires 1-31-2023)
Model COBRA Election Notice: Spanish (expires 1-31-2023)
