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 (the claims world, at least)! To access the information you are looking for in the Red Book, select from the list of section links provided below.
If you can’t find the information you’re looking for, please contact Mario Castagnola, CFSA’s risk analyst, at (916) 263-6145 or firstname.lastname@example.org.
Select the link below to go to the Red Book section of your choice:
Revenue Protection Program
Alliant Property Insurance Program
Risk Control Services
Tab 1 Checklist
Workers’ Compensation Checklist (What to do when there’s an 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
Facts About Workers’ Compensation – English
Facts About Workers’ Compensation – Spanish
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
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 Executive Director Rebecca Desmond (916) 263-6161. Pool participating fairs will also have a copy in their Red Book binder.
Memorandum of Coverage: Available from Executive Director Rebecca Desmond (916) 263-6161. Pool member fairs will also have a copy in their Red Book binder.
Excess Workers’ Compensation Insurance Certificate – available from Executive Director Rebecca Desmond (916) 263-6161. 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)
Tab 1 Checklist
General Liability Checklist (What to do when there’s an accident involving a fairgrounds visitor or visitor’s property)
Tab 3 General Liability Memorandum of Coverage (MOC)
General Liability Certificate of Participation
Certificate of Coverage (effective July 1, 2019). Available from Executive Director Rebecca Desmond (916) 263-6161. Pool member fairs will also have a copy in their Red Book binder.
General Liability Program Summary of Protection
General Liability Program Memorandum of Coverage (effective, 2019). Available from Executive Director Rebecca Desmond (916) 263-6161. Pool member fairs will also have a copy in their Red Book binder.
General Liability Program – CSAC Excess MOC Declarations (Effective July 1, 2019 -July 1, 2020). Available from Executive Director Rebecca Desmond (916) 263-6161. Pool member fairs will also have a copy in their Red Book binder.
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
CFSA Contract Insurance Requirements
Release & Waiver of Liability
Release and Waiver of Liability Agreement Form – English (2019)
Release and Waiver of Liability Agreement Form – Spanish (2019)
Insurance Information Alerts & Emergency Orders
Alert: UPDATES to CFSA Revenue Protection Program, March 11, 2020
Alert: Updates to CFSA Insurance Requirements, effective January 3, 2020
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
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 (updated 2019)
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
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: 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: 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 Event 2019 Rate Card Rates
Special Events Program Event Categories and Rates
Special Events Program online application/receipt
Special Events Program brochure (2019)
Special Events Memorandum of Coverage (Memorandum Stating the Terms and Conditions of the Special Events Program Administered by the California Fair Services Authority). The most recent MOC is available from Executive Director Rebecca Desmond (916) 263-6161. Pool member fairs will also have a copy in their Red Book binder.
Tab 5 Revenue Protection Program
Revenue Protection Program – Summary of Protection
Revenue Protection Program – New for 2020: How claims are calculated – UPDATE: INSURANCE ALERT, March 2020
How to file a claims, what to Include with your claim
Memorandum Describing the Revenue Protection Program (updated March 2020) is available from Executive Director Rebecca Desmond (916) 263-6161.
2020 Revenue Protection Program Fee Schedule
How to file a claim, what to include and who to contact:
♦ Notify CFSA
♦ Use Proof of Loss Form included with Memorandum of Coverage.
♦ Document events, (take pictures if applicable).
♦ Obtain newspaper or other articles relating to loss.
♦ Document extra (over and above normal) expenses paid to resume normal fair time or
covered interim event activities. Do not include hours normally worked.
What to include with your claim:
♦ Sworn Statement in Proof of Loss (notarization not required)
♦ Revenues from above mentioned accounts for current year. Do not include sponsorships.
♦ Newspaper clippings or articles verifying occurrence.
♦ Accounting of extra expenses paid.
Who to contact:
Mario Castagnola, Risk Analyst, email@example.com, (916) 263-6145
Can’t find the information in the Red Book that you are looking for? Please contact Mario Castagnola at (916) 263-6145 or firstname.lastname@example.org