| Forms
|
Format
|
| Agency Online Self-Administration Form |
DOC
|
|
| Agency Summary Report |
DOC
|
PDF
|
| Agent W9 |
|
PDF
|
| Agent's Request for Endorsement |
DOC
|
PDF
|
| Coverage Options for Corporate Executive Officers |
DOC
|
PDF
|
| Book of Business or Entity Change Form |
DOC
|
PDF
|
| Employee Provider Form EP-1a |
DOC
|
|
| Executive Supervisor Questionnaire (5606) |
DOC
|
PDF
|
| Independent Contractor Questionnaire |
DOC
|
PDF
|
| Professional Employer Organization New Client Form |
DOC
|
PDF
|
| Professional Employer Organization Questionnaire |
DOC
|
PDF
|
| Start Program Supplemental Application |
DOC
|
PDF
|
| Supplemental Application Aircraft Operations Information |
DOC
|
PDF
|
| Supplemental Application Longshore and
Harbor Workers' Compensation Act |
DOC
|
PDF
|
| Supplemental Application Jones Act |
DOC
|
PDF
|
| Supplemental Application Outer Continental Shelf |
DOC
|
PDF
|
| Supplemental Employee Data Worksheet |
DOC
|
PDF
|
| Supplemental Employee Data Worksheet for Temp Services |
DOC
|
PDF
|
| Trucking Industry Questionnaire |
DOC
|
PDF
|
| DWC-81, Agreement Between General Contractor and Subcontractor to Provide Workers’ Compensation Insurance |
|
PDF
|
| DWC-82, Agreement Between Motor Carrier and Owner Operator to Provide Workers’ Compensation Insurance Coverage / Agreement to Require Owner Operator to Act as Employer |
|
PDF
|
| DWC-83, Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers / Agreement to Establish Employer-Employee Relationship for Certain Building and Construction Workers |
|
PDF
|
| DWC-84, Exception to Application of Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers |
|
PDF
|
| DWC-85, Agreement Between General Contractor and Subcontractor to Establish Independent Relationship |
|
PDF
|
| Workers' Compensation- Request for Information (WC- RFI, formerly known as the ERM-14) |
DOC
|
PDF
|
For more forms related to workers’ compensation insurance or general workplace issues,
visit the appropriate agency’s website, listed below.
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