The forms below are available for your use in Adobe PDF.
 

ACORD Application (130)

ACORD Commercial Insurance Application (125)

ACORD Certificate (25-S)

Application for Exclusion from Coverage (Individual, Partner or Other & Corporate Officer) (U-116)

Application for Exclusion from Coverage Limited Liability Company Member/Managers (U-135)

WorkSafe Credits Request Form (U-141)

Supply Order Form (MK-07)

Early Reporting Flyer (BD_12052)
Describes the benefits of reporting claims as quickly as possible.

Accident Fund Highlight Flyer (CC_2023)
A single sheet that highlights Accident Funds performance and history.

Confidential Request for Information (ERM-14)

Official Questionnaire (U-88)

File Audit Checklist (BD-11149)
  To verify your agency's policyholder file contains the appropriate information in preparation
  for your business development consultant's audit.

Determination of Worker Status
Policyholders submit this form to request the determination of the status of a worker for the purpose of completing his or her workers compensation audit.