The following are commonly used forms for agents and policyholders. The file type is indicated to the right of each document. Most of these documents are in PDF format and require the Adobe Acrobat Reader. If you do not have the reader, you can download it for free here.
Agent Forms Interactive Registration Form - Agents (.pdf)
Employer Forms and Documents Compliance Poster (.pdf) First Report of Injury (State WC) (.pdf) First Report of Injury (Longshore) (.pdf) Interactive Registration Form - Policyholders (.pdf) Overtime Defined (.pdf) Sample Drug-Free Workplace Policy (.pdf) Sample Seatbelt Policy (.pdf) Second Injury Fund Medical History Questionnaire (.pdf)
Policyholder Resources Building a Small Business Operational Safety Plan (.pdf) Certificates of Insurance (.pdf) Claims Management (.pdf) Fraud Reporting Kit (.pdf) Injury Reporting (.pdf) LWCC at a Glance (.pdf) Longshore & Maritime Guide (.pdf) Loss Prevention (.pdf) Premium Audit (.pdf) Second Injury Fund (.pdf)
Safety Posters Drug-Free Workplace Safety (.pdf) Fire Extinguisher Safety (.pdf) Lifting Safety (.pdf) Personal Protective Equipment (.pdf) Vehicle Safety (.pdf)
Spanish Language Forms Second Injury Fund Medical History Questionnaire - Spanish (.doc) Second Injury Fund Medical History Questionnaire - Spanish (.pdf) |