Resources
Workers’ Comp Forms Library
This is the workers’ comp forms library: certificates, claim reporting documents, and the paperwork clients and carriers ask staffing agencies for most often. Individual forms are added here as they’re finalized.
If you need a specific form now and don’t see it listed, call (561) 990-3022 and we’ll get it to you directly. Agents submitting a risk on a client’s behalf should use the agent submission portal instead of this library.
Looking for something else, browse the full resources library or request a quote.
Loss History Affidavit
Required with every quote. An owner or officer certifies the company's workers' comp claim history for the prior three years — used when carrier, PEO, or payroll-company loss runs are not available.
Staffing Supplemental
Staffing firms only. The underwriting supplemental: ownership and any related or predecessor entities, years in business, states of operation, current experience mod, and the document checklist carriers expect with the submission.
Client List Master
Staffing firms only. One row per client you staff: work location, class code, headcount, estimated payroll, the duties performed, and whether there is height or driving exposure.
Intake Form
Staffing firms only. Your agency's basics on one line: legal name, address, EIN, years in business, type of staffing, and the best contact for the account.
Rather just send what you have?
Start the quote and we'll tell you exactly which documents your account actually needs.