The CFSA Red Book

If Information is Power,  then CFSA’s  Claims & Loss Reporting Guide, aka the Red Book,  is primed to take over the world!  To access the Red Book, simply look for the program you are interested in and choose your topic from the tab sections.

If you can’t find the information you’re looking for, please contact Lianne Lewellen, CFSA’s risk analyst, at (916) 263-6145 or llewellen@cfsa.org.

Thank you!


The Red Book
CFSA’s Claims and Loss Reporting Guide
4th Edition – Table of Revisions
Claims & Loss Reporting Guide – Introduction
Who’s Who in CFSA’s Claims Department

Select the link below to go to the Red Book section of your choice:
Workers’ Compensation
General Liability
Special Events
Revenue Protection Program
Alliant Property Insurance Program
Risk Control Services

 

WORKERS’ COMPENSATION

Tab 1  Checklist
Workers’ Compensation Checklist  (What to do when there’s a accident involving a fair employee)

Tab 2  Claim Form
How to Fill Out the DWC-1 Form: Employee Claim for Workers’ Compensation Benefits
•DWC-1 Sample Form

Tab 3  The Employer’s Report and Supervisor’s Reports
How to Fill Out the Employer’s Report of Occupational Injury or Illness: Form 5020
• Sample Form 5020
• Online Form 5020 (to come)
How to Fill Out the Supervisor’s Report of Work Injury: WCSR Form
• WCSR Form
• Online WCSR (to come)

Tab 4  Accident Investigations and Cal/OSHA 300 Log
Accident Investigation: What to do when…
• Accident Investigation tab
Accident Investigation: definitions and details
•  Form WPP-1 Job Safety Analysis tab
Job Safety Analysis Form
•  Cal/OSHA Accident Notification Record tab
Cal/OSHA Accident Notification Record
• Cal/OSHA Telephone Numbers tab
Cal/OSHA Phone Numbers for reporting serious injuries or fatalities
•  Cal/OSHA Form 300
Cal/OSHA Form 300 aka the 300 Log
Cal/OSHA Forms for Recording Work-Related Injuries and Illnesses

Tab 5  Industrial Disability Leave
Industrial Disability Leave (IDL)
IDL- Frequently Asked Questions Exhibit A
IDL – with Supplementation Benefits Information and Option Selection Form  Exhibit B
Temporary Disability Verification of State Employee Form  Exhibit C

Tab 6  Job Displacement Vouchers
Job Displacement Vouchers
Supplemental Job Displacement Non-Transferable Voucher Form for Injuries Occurring On or After January 1, 2013

Tab 7 Pamphlets and Posters
Employee Pamphlet
Facts About Workers’ Compensation – English
Facts About Workers’ Compensation – Spanish
Posting Notices
Notice to Employees Injuries Caused by Work (State of California – Department of Industrial Relations) – English and Spanish
Employee’s Designation of Personal Physician or Chiropractor
Employee’s Designation of Personal Physician Form
Employee’s Designation of Personal Chiropractor Form

Tab 8 General Information
Declaration Pursuant to Labor Code Section 4906(G)
Declaration Form: WCAB-4906-G
Nondiscrimination Policy
Serious and Willful Misconduct of an Employer
Temporary and Permanent Disability Benefits
Temporary Disability Fact Sheet
Permanent Disability Fact Sheet

Tab 9 Workers’ Compensation Coverage
Summary of Protection: Workers’ Compensation Risk Sharing Pool program
Memorandum of Coverage: Cover page  – available from Tom Amberson at tamberson@cfsa.org or (916) 263-6163. Pool member fairs will also have a copy in their Red Book binder.
Memorandum of Coverage:  Available from Tom Amberson at tamberson@cfsa.org or (916) 263-6163. Pool member fairs will also have a copy in their Red Book binder.
Excess Workers’ Compensation Insurance  Certificate – available from Tom Amberson at tamberson@cfsa.org or (916) 263-6163. Pool member fairs will also have a copy in their Red Book binder.

Tab 10 Community Service Workers and Volunteers
Community Service Workers/Alternate or Assigned Work Programs
Workers’ Compensation for Volunteers
Form 1. Workers’ Compensation Agreement (county provides WC coverage)
Form 2. Workers’ Compensation Agreement (fairground  provides the WC coverage)

 


GENERAL LIABILITY
Tab 1  Checklist
General Liability Checklist
 (What to do when there’s an accident involving a fairgrounds visitor or visitor’s property)

Tab 2  Accident Report
Accident and Loss Reporting
– Introduction to the Accident Reporting Form
Accident Report Form
General Accident Reporting –  What accidents should be reported?

Tab 3  General Liability Memorandum of Coverage (MOC)
General Liability Certificate of Participation
Certificate of Coverage (September 1, 2018).  Available from Tom Amberson at tamberson@cfsa.org or (916) 263-6163. Pool member fairs will also have a copy in their Red Book binder.
General Liability Program Summary of Coverage
General Liability Program Memorandum of Coverage
  (August 1, 2018).  Available from Tom Amberson at tamberson@cfsa.org or (916) 263-6163. Pool member fairs will also have a copy in their Red Book binder.
General Liability Program – CSAC Excess MOC Declarations (August 1, 2018).  Available from Tom Amberson at tamberson@cfsa.org or (916) 263-6163. Pool member fairs will also have a copy in their Red Book binder.
CFSA’s Insurance Requirements, 2017
Insurance Requirements, June 1, 2012
General Liability Program Operating Memorandum #06-01
General Liability Program  Operating Memorandum #06-02
General Liability Program Operating Memorandum #06-03
General Liability Emergency Order – Petting Zoo Coverage

Release & Waiver of Liability
Participant Liability
Release and Waiver of Liability Agreement Form – English
Release and Waiver of Liability Agreement Form – Spanish 

Contract Review
Contract Review Procedures for Fairs, with the Hazardous Activities and Events (not fair sponsored) and Non-Hazardous Activities  lists
Certificate of Liability Insurance – ACORD® form

Insurance Information Alerts & Emergency Orders
Alert:
Changes to CFSA Insurance Requirements for all Fair Contractors and Facility users Related to all Motorized Events and Swap Meets/Flea Markets #18-01, including the General Liability Program Operating Memorandum #18-01 (December 11, 2017)

Alert: CFSA General Liability Operating Memorandum #17-01; Revised Hazardous Activities and Events to Include Drones and Cannabis Festivals/Trade Shows; Revised Additional Insured Language on Insurance Certificates
• General Liability Operating Memorandum #17-01
Insurance Requirements 2017

Alert:
Updated CFSA Insurance Requirements (June 20, 2012)

Alert: Insurance Certificate Review (August 8, 2011)

Alert: Fairgrounds Dress Codes – Update (November 9, 2007)

Alert: New CFSA-approved Participant Release and Waiver Forms
• Sample Waivers in English and Spanish

Alert:
General Liability Operating Memorandums #06-02 and #06-03 : #06-02 for some reductions in minimum liability limits for certain activities; revised additional insured language on insurance certificates; and #06-03 for fair-promoted motorized and rodeo events
• General Liability Operating Memorandum #06-02
• General Liability Operating Memorandum #06-03
Insurance Requirements (June 1, 2006)

Emergency Order: Petting Zoos Without CFSA-approved Liability Coverage (June 3, 2005)

Alert:
General Liability Operating Memorandum #06-01: Petting Zoos (April 27, 2006)
• General Liability Program Operating Memorandum #06-01

Alert: Pari-mutual Operations (June 17, 2005)

Alert: General Liability Program Operating Memorandum #05-01 Fair Promoted  Motorized and Rodeo Events (October 20, 2004)
• General Liability Program Operating Memorandum #05-01

Alert : Insurance Requirements for Mechanical Bulls (May 7, 2004)

Alert:
Liquor Liability Insurance Requirements

Alert: General Liability Operating Memorandum #03-01: Modifications to Indemnity
Language and Non-compliance Policy (May 8, 2003)
• General Liability Program Operating Memorandum #03-01 (June 1, 2003)
• General Liability Operating Memorandum of Coverage  #02-01 (April 2002)
• General Liability Operating Memorandum of Coverage #01-01 (January 2000)

Alert: Fairground Dress Codes (April 30, 2003)
Alert:
Fairground Dress Code (August 14, 2002)

Alert: Medical Malpractice Insurance Requirement (May 1, 2002)

Alert:
Use of Special Events Program for Off-site Facilities (April 6, 2001)

Alert:
Independent Animal Exhibitors: Liability Coverage (March 2001)

Tab 4  Special Events
Summary of Protection – Special Events Program (January 1, 2018)
Special Events Program and Claims Reporting (December 18, 2017)
Special Events Program Evidence of Coverage
Special Events Program Coverage Procedures
Special Events Program Rate Card
Special Events Program Event Categories and Rates
Special Events Program online application/receipt
Special Events Program Brochure (2017)
Special Events Memorandum of Coverage (2018)  (Memorandum Stating the Terms and Conditions of the Special Events Program Administered by the California Fair Services Authority).  The MOC is available from Tom Amberson at tamberson@cfsa.org or (916) 263-6163. Pool member fairs will also have a copy in their Red Book binder.

Tab 5 Revenue Protection Program
Revenue Protection Program – Certificate of Participation
Revenue Protection Program – Summary of Protection
Revenue Protection Program – How claims are calculated, how to file a claim, what to include, who to contact
Memorandum Describing the Revenue Protection Program, including the Sworn Statement/Proof of Loss Form
Revenue Protection Program Fee Schedule

Tab 6  Alliant Property Insurance Program
Property Insurance Program – Certificate of Participation
Property Insurance Program – Summary of Protection

Tab 7  CFSA Insurance Guidelines
2018 Insurance Guidelines

Tab 8  Risk Control Services
Get to Know CFSA’s Risk Control Specialists
Risk Control Services
Loss Control Bulletins

Can’t find the information you’re looking for? Please contact Lianne Lewellen at (916) 263-6145 or  llewellen@cfsa.org