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!  We just finished a major update to the information in the Red Book (April 2018) and we are now in the process of adding the complete binder to our website, chapter by chapter. Follow our progress, below!

If you’re looking for information that’s not yet online, please refer to your fair’s copy of the Red Book, or contact Lianne Lewellen, (916) 263-6145.

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
Risk Control

 

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

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 Workers’ Compensation Risk Sharing Pool program
Memorandum of Coverage: Workers’ Compensation Risk Sharing Pool program
Excess Workers’ Compensation Insurance  Certificate

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  (Table of Contents)
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 (with instructions on how to fill it out, save, print and email it to CFSA through our website). You will receive a message alerting you that the form has successful submitted. Remember to make a copy of the form for your fair’s files.
General Accident Reporting –  What accidents should be reported?

Tab 3  General Liability Memorandum of Coverage
General Liability Memorandum of Coverage  (currently undergoing revision –  4/2018)
General Liability Program Operating Memorandum #06-01
Insurance Requirements, June 1, 2012
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
Hazardous Activities and Events (not fair sponsored) List
Non-Hazardous Activities

 

 

 

Tab 4  Special Events
Special Events program and Claims Reporting
Revenue Protection
Pooled Property Protection Program
Insurance Guidelines
Safety Services