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FW'E&dwz"1w Mir wVVG/Uw( <br /> WORKER ' COMPENSATIOA NOTICE <br /> ............................INTERN.All.ONAL..TECHK.OL.OGY-C.ORPORA71ON <br /> . ...................................................................................... <br /> Wce is hereoy given OW this emptoyer is insured <br /> .............................. . <br /> forWariters' Compensation. in compliance CWW OF MMURMCE CGUPJWV) <br /> with the I"s Of the _UNIX Of California......... <br /> Address of nearest claims office aW telephone <br /> UWer the California Labor Cade. in the a Of Injury,you have the ript to request a change of treating physician <br /> If the <br /> original treating physician is selected inldallY by the OmPkw. TWft(3M days after reportft an <br /> by a ptqWcian at your own cho=.Upon sokcft a phy injury you can be trusted <br /> -!an thft 00 do"after rep"ng the injury,you should imn i <br /> Sir <br /> ataly notify your ernP10W Of the name and address Of they OWN eh ld Ped <br /> If you wish direct initial medical tmaune"L other than 4PPF013'kft*nwVncy@rftrst aid treatment.by your own desiMt- <br /> ad physician in the wwt of'niury, you must nWfY YQw 6011310Yu of-your choice in writing prior W injury. <br /> If YOU are UftWe to return to work due to the lnWry,you have the not to recebe tonP01aY 0r permanent Isai I"y income if eligible, vocational rahmbilitation services. <br /> Additional benefits we available if the iniuFY "Mits in death. <br /> Report my a=*-?eJ&ftd injury or illness to YOUr supervisor or employer as saw as Possible. Provide all necessary informa- <br /> tion nq1srWng injury or illness. <br /> For further information. MOM Contact your supervisor or employer. you may also contact an Information and Assistance <br /> Officer at the Office of Benefit Assistance and Enforcement located at..._................... <br /> .............. Low <br /> �Vy� M.9-Q2vurL.56CA 2 r 9 <br /> EMERGENCY TELEPHONE NUMBERS <br /> H*:;4t-'w t mLxS /";7r& cower"" ew <br /> cw <br /> Aftuhmca.._...... ...... .......... <br /> Fife Department Police Department <br /> OFF-DUTY ACTIVITIES OF EMPLOYEE(S) <br /> Your emVkW Or its insure=CWRPIM PW not be rupDnsibie for ate# bwjun&of an in jury due to the ompWM,s <br /> volitntary perftpStion in any Off-duty recreational.social.or athletic Activity that Is not part of the omptope's wwk-related <br /> dutkm <br /> WC 8337e (Ed. 1-900) umwoofw pmmT"%G&SUFTLy. !Nc. <br />