Special Resources » Forms: Insurance
Download a large number of workers compensation forms. Sample bid package - forms, checklists, etc. used by a university's risk management department. Series of risk management forms and letters. Forms for life & health, property casualty, WC insurance, etc.
The following is the collection of special resources throughout the library. Click on main category / sub-category for that section of the library OR Click on resource title for immediate access to the resource.
RFP - Risk Management Information Systems [32362] 
Example of a request for proposal for claims processing software
Example of a request for proposal for claims processing software
Workers Compensation Injury Report Codes [15599]
Examples of injury report codes used by a state agency
Examples of injury report codes used by a state agency
Agreement about Driving - Elderly [18319]
Sample form to assist with planning ahead for a time when a person must stop driving
Sample form to assist with planning ahead for a time when a person must stop driving
Fleet Safety » Fleet Policies
Sample fleet-related company policies - vehicle use, drivers, seat belts, etc.
Sample fleet-related company policies - vehicle use, drivers, seat belts, etc.
Insurance Loss Control » Business Interruption
Contingency planning and business interruption materials
Contingency planning and business interruption materials
Business Continuation Expense Worksheet ![[pdf]](graphics/file_pdf.gif)
[26070]
Designed as an aid in calculating expected Business Interruption expenses (pdf)
[26070] Designed as an aid in calculating expected Business Interruption expenses (pdf)
Business Interruption Worksheet [14517]
Fill in the blank form assists with insurance needed calculations
Fill in the blank form assists with insurance needed calculations
Insurance Loss Control » Construction Insurance
Risk management and insurance related issues in the construction industry
Risk management and insurance related issues in the construction industry
Construction Insurance/Risk Management Checklist [11644]
Checklist to audit your construction risk management/insurance programs
Checklist to audit your construction risk management/insurance programs
Employment Practices Risk Management Audit [9621]
Self audit related to hiring practices, terminations, etc.
Self audit related to hiring practices, terminations, etc.
Procedures Manual for Insurance Requirements in Contracts [15570]
Full text of a hold harmless agreement and insurance contract requirements used by a state agency
Full text of a hold harmless agreement and insurance contract requirements used by a state agency
Insurance Loss Control » OCIP
Owner Controlled Insurance Programs (OCIP), construction wrap up materials
Owner Controlled Insurance Programs (OCIP), construction wrap up materials
Insurance Loss Control » Product Liability
Insurance articles, legal resources related to product liability
Insurance articles, legal resources related to product liability
Property Claims Checklist [19357]
The following is a checklist of steps to take in the event of loss
The following is a checklist of steps to take in the event of loss
Property Loss Preparedness Checklist [19358]
The following is a checklist that should help determine your loss preparedness
The following is a checklist that should help determine your loss preparedness
Reinsurance & Arbitration [20770]
Reinsurance specific arbitration and mediation information - such as sample forms
Reinsurance specific arbitration and mediation information - such as sample forms
Insurance Loss Control » Risk Control Programs
Full text of risk management policy and procedure manuals
Full text of risk management policy and procedure manuals
GA-Georgia Comprehensive Loss Control Program [35941] This program helps state agencies develop a Risk Management culture to increase safety awareness and reduce claims
ID-Idaho Safety and Loss Control Program Model [16734]
Recommended elements of a safety and loss control program for state agencies - forms, checklists
[16734] Recommended elements of a safety and loss control program for state agencies - forms, checklists
CT-Connecticut State Insurance Risk Management Board [19675]
Serving Insurance and Risk Management Needs of Connecticut State Agencies, Colleges, Universities
Serving Insurance and Risk Management Needs of Connecticut State Agencies, Colleges, Universities
Website Risk Management Checklist [35702]
Covers intellectual property, privacy, and communications liability
[35702] Covers intellectual property, privacy, and communications liability
Reasonable Accommodation Checklist [35937] Steps to take for accommodating an injured employee's return to work
Occupational Medicine » Medicare
Center for Medicare & Medicaid Services - directories, fees, contracts
Center for Medicare & Medicaid Services - directories, fees, contracts
Medicare Professional & Technical Information [7829]
Information for physicians, health care professionals, researchers, etc.
Information for physicians, health care professionals, researchers, etc.
RFP - Liability & Workers Compensation Risk Financing Study [15691]
Full text of a sample RFP for expert advice regarding risk financing for liability & WC
Full text of a sample RFP for expert advice regarding risk financing for liability & WC
RFP - Workers Compensation Claim Audit & Actuarial Study [15689]
Full text of a sample RFP for a claims audit and actuarial study
Full text of a sample RFP for a claims audit and actuarial study
RFP - Workers Compensation Claims Administration [15688]
Full text of a sample RFP used by a municipality for TPA services
Full text of a sample RFP used by a municipality for TPA services
RFP: Workers Compensation TPA [18700]
16 page sample request for proposal for a Third Party Administrator for WC
16 page sample request for proposal for a Third Party Administrator for WC
CA-California Standard Broker Fee Disclosure & Fee Agreement [27887]
Summary of the state regulations and sample standard forms
Summary of the state regulations and sample standard forms
CA-California University Risk Management Forms [14039] Insurance & liability forms in use by a major university
Case Management Techniques for Major Fire Losses [23626]
Checklist provides a snapshot into the many action items that must be faced on a major claim
Checklist provides a snapshot into the many action items that must be faced on a major claim
Checklist for Handling Worker's Compensation Claims [21552]
Checklist for collecting information about the WC claim
Checklist for collecting information about the WC claim
Checklist for Responding to and Securing Insurance for a First Party Property Loss [24084]
What to do in the event of a property loss
[24084] What to do in the event of a property loss
Claims Management Audit Program [27551]
Internal audit report form - claims management internal control questionnarre
[27551] Internal audit report form - claims management internal control questionnarre
Commercial Lines Application Forms [15967]
Application forms from a commercial lines carrier - listed by insurance program
Application forms from a commercial lines carrier - listed by insurance program
Contractor Risk Profile Form [25372]
Helps to understand the risks inherent in the contractor's operations
Helps to understand the risks inherent in the contractor's operations
Exposure Reporting Manual [23422]
Rating basis by line of coverage - includes instructions and forms
Rating basis by line of coverage - includes instructions and forms
Facilities Use Hold Harmless Agreement & Insurance Requirements [27931]
Example of the guidelines/form used by the State of Idaho for state owned buildings
[27931] Example of the guidelines/form used by the State of Idaho for state owned buildings
Health Benefits Administration Program Audit ![[doc]](graphics/file_doc.gif)
[27554]
Review procedures for accuracy of claim payments and efficiency of operation
[27554] Review procedures for accuracy of claim payments and efficiency of operation
ID-Idaho L&H Insurance Producer Fee Disclosure Form [27892]
Sample form used by insurance brokers in Idaho to disclose broker service fees to clients
[27892] Sample form used by insurance brokers in Idaho to disclose broker service fees to clients
Insurance & Risk Management Program Audit [26074]
Checklist for auditing a firm's insurance risk management program
Checklist for auditing a firm's insurance risk management program
Insurance Carrier Safety Checklist [4804]
Checklist designed to help you evaluate your insurance carrier's safety services
Checklist designed to help you evaluate your insurance carrier's safety services
Insurance Claim Checklist [35165]
Gather the information claim representatives are most likely to need when a claim is reported
Gather the information claim representatives are most likely to need when a claim is reported
Insurance Claims Audit Procedures [26073]
General and motor vehicle claims audit procedures checklist (pdf)
[26073] General and motor vehicle claims audit procedures checklist (pdf)
Insurance Policy Reconstruction Checklist [24082]
Checklist of sources for policies or secondary evidence of coverage
[24082] Checklist of sources for policies or secondary evidence of coverage
M&A Due Diligence Checklist [14010]
Property/casualty insurance risks that arise out of fortuitous events
Property/casualty insurance risks that arise out of fortuitous events
Medical Claims Audit of Third Party Administrators [27553] A sample audit with focus on self-insured medical plan and prescription drug plan
Model Risk Transfer Clauses: Construction Agreements [8213]
Full text of a sample risk transfer clause for use in a construction contract
Full text of a sample risk transfer clause for use in a construction contract
Model Risk Transfer Clauses: Construction Contracts with Hazardous Materials [9772]
Full text of a sample risk transfer clause for use in a construction contract involving hazmat
Full text of a sample risk transfer clause for use in a construction contract involving hazmat
Model Risk Transfer Clauses: Facilities Use [12202]
Model risk transfer agreement for facilities use
Model risk transfer agreement for facilities use
Notice of Claim Form [7934]
For claims related to injury to person or damage to personal property presented to a city
For claims related to injury to person or damage to personal property presented to a city
Notice of Loss Forms [19676]
Forms in use by the state agenies in Connecticut to report insurance losses
Forms in use by the state agenies in Connecticut to report insurance losses
Property and Casualty Forms [23619]
Sample forms for workers comp, central fleet management and much more
Sample forms for workers comp, central fleet management and much more
Property and Casualty Internal Controls Questionnaire [26080]
17 page internal controls audit for property and casualty insurance operations (pdf)
[26080] 17 page internal controls audit for property and casualty insurance operations (pdf)
Property/Liability Forms [15598]
Includes risk management forms as well as the full text of the manual
Includes risk management forms as well as the full text of the manual
Risk Management Department Audit [26078]
Step by step process of conducting an audit of a risk management department with commercial insurance responsibilities
Step by step process of conducting an audit of a risk management department with commercial insurance responsibilities
Risk Management Forms [10997]
A series of risk management forms in use by a major university in Canada
A series of risk management forms in use by a major university in Canada
Risk Management Program Audit [26077]
Checklist for conducting and insurance risk management program audit
Checklist for conducting and insurance risk management program audit
Subcontract Audit Form [25373]
Form used to audit subcontract documents and subcontractor certificates of insurance
Form used to audit subcontract documents and subcontractor certificates of insurance
TPA Employee Health Care Benefits Audit Program [27552]
Third Party Administrator Internal Audit Procedures checklist
Third Party Administrator Internal Audit Procedures checklist
WI-Wisconsin Risk Management Forms [14516] Full text of risk management forms in use by a major university
Workers Compensation Forms [26354]
Includes typical claims administration questionnaires and WC policy forms
Includes typical claims administration questionnaires and WC policy forms
Safety Forms » Safety Audits
Regulatory compliance self-inspections, program audits, self-evaluations
Regulatory compliance self-inspections, program audits, self-evaluations
Comprehensive Loss Control Plan Evaluation Checklist [35940] A sample program audit checklist used by a state to evaluate their state agency loss control programs
AK-Alaska - Workers Compensation Forms [6243]
Download Alaska workers compensation forms, first report of injury and more
Download Alaska workers compensation forms, first report of injury and more
AR-Arkansas - Workers Compensation Forms [1568]
Nearly 20 different workers compensation forms for the state of Arkansas may be downloaded
Nearly 20 different workers compensation forms for the state of Arkansas may be downloaded
AZ-Arizona - Workers Compensation Forms [10615]
Workers comp forms, self-insured forms, ADOSH forms and more
Workers comp forms, self-insured forms, ADOSH forms and more
CA-California - Self-insured WC Forms [4957]
Download workers compensation forms for the state of California self-insureds
Download workers compensation forms for the state of California self-insureds
CA-California - WC Forms in Numerical Order [4950]
Download physician and employer first report of injury forms, etc for the state of California
Download physician and employer first report of injury forms, etc for the state of California
CA-California - Workers Compensation Forms [10303]
Download a set of WC forms for the state of California
Download a set of WC forms for the state of California
CO-Colorado Questionable WC Claim Notice [34241]
Example of an attachment to First Notice of Loss when employer doubts injury has occurred
[34241] Example of an attachment to First Notice of Loss when employer doubts injury has occurred
CT-Connecticut - Workers Compensation Forms [3541]
Large number of forms from the Connecticut Workers Compensation Commission
Large number of forms from the Connecticut Workers Compensation Commission
FL-Florida - Workers Compensation Forms [4959]
Download over 50 commonly used workers compensation forms for Florida
Download over 50 commonly used workers compensation forms for Florida
GA-Georgia - Workers Compensation Forms [6267]
Download a large number of workers compensation forms for the state of Georgia
Download a large number of workers compensation forms for the state of Georgia
GA-Georgia Subsequent Injury Trust Fund Claim Forms [20036] Also provides statutory filing requirements
ID-Idaho - Workers Compensation Forms Used by the Industrial Commission [6251]
Download WC forms for the state of Idaho
Download WC forms for the state of Idaho
KS-Kansas - Workers Compensation Forms [3903]
Download a large number of WC forms for the state of Kansas
Download a large number of WC forms for the state of Kansas
KS-Kansas Self Insurance Forms [11205]
Download Kansas WC self-insurance application forms - spreadsheets
Download Kansas WC self-insurance application forms - spreadsheets
KY-Kentucky - Workers Compensation Forms [4966]
Download forms used for workers compensation in Kentucky
Download forms used for workers compensation in Kentucky
LA-Louisiana - Workers Compensation Forms & Instructions [7972]
Download WC forms for the state of Louisiana
Download WC forms for the state of Louisiana
MA-Massachusetts - Workers Compensation Forms [6259]
Download WC forms for the state of Massachusetts
Download WC forms for the state of Massachusetts
MI-Michigan - Workers Compensation Forms [5788]
Download WC forms, including the Employers Basic Report of Injury
Download WC forms, including the Employers Basic Report of Injury
MO-Missouri - Workers Compensation Forms [10080]
Download frequently used workers compensation forms
Download frequently used workers compensation forms
MT-Montana - Workers Compensation Court Forms [10092]
Download legal forms for the Workers Compensation Court of Montana
Download legal forms for the Workers Compensation Court of Montana
NC-North Carolina - Workers Compensation Forms [4986] Download forms required for workers compensation in North Carolina
NE-Nebraska: Workers Compensation Forms [3020]
Download forms related to workers compensation in Nebraska
Download forms related to workers compensation in Nebraska
NJ-New Jersey - Workers Compensation Forms & Brochures [6286]
Download workers compensation forms for the state of New Jersey
Download workers compensation forms for the state of New Jersey
NM-New Mexico - Workers Compensation Forms [6288] Download workers compensation forms for the state of New Mexico
NY-New York - Workers Compensation Forms [4979]
Download commonly used forms required for WC in the state of New York
Download commonly used forms required for WC in the state of New York
NY-New York Independent Medical Examination (IME) Forms [15221]
Download IME forms for the state of New York
Download IME forms for the state of New York
OR-Oregon - Workers Compensation Forms [4984]
Download a very large number of workers compensation forms for Oregon
Download a very large number of workers compensation forms for Oregon
RI-Rhode Island - Workers Compensation Forms [16124]
Download WC forms for the State of Rhode Island
Download WC forms for the State of Rhode Island
SC-South Carolina Workers Compensation Forms [23170]
Download a series of workers compensation forms for the state of South Carolina
Download a series of workers compensation forms for the state of South Carolina
SD-South Dakota - Workers Compensation Forms [13521]
Download WC forms including First Report of Injury for South Dakota
Download WC forms including First Report of Injury for South Dakota
TN-Tennessee WC Forms [14401]
Download a series of workers compensation forms for the state of Tennessee
Download a series of workers compensation forms for the state of Tennessee
US Division of Coal Mine Workers' Compensation Forms - Black Lung [29025]
OWCP forms for federal workers to apply for workers compensation benefits under Black Lung benefits
OWCP forms for federal workers to apply for workers compensation benefits under Black Lung benefits
US Division of Energy Employees Occupational Illness Compensation Claims Forms [29026]
Claims forms for benefits under the Energy Employees Occupational Illness Compensation Program Act
Claims forms for benefits under the Energy Employees Occupational Illness Compensation Program Act
US Division of Federal Employees’ Compensation Forms [29023]
OWCP forms for federal workers to apply for workers compensation benefits
OWCP forms for federal workers to apply for workers compensation benefits
US Division of Longshore and Harbor Workers' Compensation Forms [29024]
OWCP forms for federal workers to apply for workers compensation benefits under Longshore benefits
OWCP forms for federal workers to apply for workers compensation benefits under Longshore benefits
VA-Virginia - Workers Compensation Commission Forms [13084]
Download WC forms for the state of Virginia - self-insurance forms, etc
Download WC forms for the state of Virginia - self-insurance forms, etc
WI-Wisconsin - Workers Compensation Forms [4803]
Access a variety of forms (e.g., first report of injury) related to workers compensation
Access a variety of forms (e.g., first report of injury) related to workers compensation
WV-West Virginia - Workers Compensation Forms [4782]
The following forms are approved for use in West Virginia workers� compensation claims
The following forms are approved for use in West Virginia workers� compensation claims
Security » Business Security
Crime-free workplace, corporate security, business protection from burglary
Crime-free workplace, corporate security, business protection from burglary
Retail Security - Preventing Crime Losses [27962]
Security checklist with a focus on retail jewelry sales crime loss prevention
Security checklist with a focus on retail jewelry sales crime loss prevention
Public Entity Loss Control Manual [24830]
15 chapter manual for municipalities, county governments, state agencies, etc.
15 chapter manual for municipalities, county governments, state agencies, etc.
Self Insurance: Alaska Employer Guidance for WC Self Insurance [11151]
Series of documents, forms, etc. related to self-insurance in the State of Alaska
Series of documents, forms, etc. related to self-insurance in the State of Alaska
Self Insured Employers WC Forms [23181]
Download WC forms for self-insured employers in the State of Arizona
Download WC forms for self-insured employers in the State of Arizona
Self Insurance: Connecticut: Employer Self-Insurance Application Package [11201]
Information package for employers wishing to self-insure their WC liabilities - includes forms
[11201] Information package for employers wishing to self-insure their WC liabilities - includes forms
Self-Insurer WC Application - Louisiana [23188]
Download the application to become self-insured for WC in LA
Download the application to become self-insured for WC in LA
Missouri WC Self-Insurance Program [15295]
Information and forms for the Missouri self-insurance program for WC
Information and forms for the Missouri self-insurance program for WC
Self Insurance: New Hampshire Self Insurance Statutes and Application [11233]
Provides links to the WC self-insurance laws and can download the self-insurance application
Provides links to the WC self-insurance laws and can download the self-insurance application
Self Insurance Information - New York WC [5012]
Information for self insuring for workers compensation in the State of New York
Information for self insuring for workers compensation in the State of New York
Plain Language Summary of Law Changes [20929]
A brief summary of legislative changes to the Worker’s Compensation Act
A brief summary of legislative changes to the Worker’s Compensation Act
West Virginia WC Self-Insurance Program [11270]
Download forms, checklists and general information about self-insurance in West Virginia
Download forms, checklists and general information about self-insurance in West Virginia
Forms - Division of Longshore and Harbor Workers' Compensation [11747]
Download approximately 20 forms
Download approximately 20 forms
Workers Compensation » WC Programs
Support materials for implementation of workers compensation programs
Support materials for implementation of workers compensation programs
NV-Nevada Risk Management Program [15585]
Forms, program materials, checklists for state agencies in Nevada
Forms, program materials, checklists for state agencies in Nevada
State Workers Compensation Program [14523]
Full text of the WC program and forms in use by a state government for their employees
Full text of the WC program and forms in use by a state government for their employees
Workers Compensation » WC Return to Work
Managing workers compensation costs by returning injured workers to work
Managing workers compensation costs by returning injured workers to work
14 Day Injury Report Form [34242]
Example of a form to be completed when an injured employee has been off the job for 14 days due to the injury
[34242] Example of a form to be completed when an injured employee has been off the job for 14 days due to the injury
Chapter 5 Return to Work Program [9428]
Full text of WC return to work program for state agencies in Texas - plus, checklist & forms
Full text of WC return to work program for state agencies in Texas - plus, checklist & forms
GA-Georgia Return to Work Program [19674] An explanation of the state of Georgia's RTW program for state employees
Implementing a Job Task Bank [25367]
Steps for creating a list of duties that can be offered to an injured worker who is returning to work
[25367] Steps for creating a list of duties that can be offered to an injured worker who is returning to work
MN-Minnesota Injured Workers Responsibilities [18392]
A sample policy statement to be signed by the injured worker
[18392] A sample policy statement to be signed by the injured worker
Modified Duty Employee Acknowledgement Form [26466]
A sample form that is signed by the injured worker to accepts a modified work assignment (pdf)
[26466] A sample form that is signed by the injured worker to accepts a modified work assignment (pdf)
Temporary Modified Duty for Industrial Injuries [16322]
Text of a policy that outlines the procedures plus a sample letter to be sent to the injured worker
Text of a policy that outlines the procedures plus a sample letter to be sent to the injured worker
Transitional Employment Plan [35938] A form for use in outlining the plan specifications for returning an injured employee to work
Uniform Workability Report Form [23461]
Provides essential management information concerning the health status of an injured worker after each physician visit
Provides essential management information concerning the health status of an injured worker after each physician visit
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