Employer Forms

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Endorsements Acceptable in Wisconsin

Standard endorsements accepted in Wisconsin

Endorsements N/A in Wisconsin

Listing of endorsements not accepted in Wisconsin

Bureau Request Form

Request employer specific information such as rating or experience modification data or five-year premium and loss exhibit, etc.

Business Operations Report

Insureds use to provide self inspection business operation details

Carrier Support Request

For carriers to request one-on-one problem resolutions

Employer 'FindMyMod' Access Request

Misplaced your Employers Experience Rating access instruction letter? Request WCRB to resend

ERM-6 (12/7/04)

Self-insureds use to submit experience rating data

Electronic ERM-14

Insureds use to report ownership changes

Information Release Authorization Form - IRAF (5/9/06)

Allows insureds to authorize WCRB to release information to a designated entity

Inspection Request

Request an on-site operational review of the insured’s business

Pool Payroll Report

Pool policy holders create a Pool Payroll Report

Additional information can be found in the WCRB Website Member User Guide

Authorizing Officer Change Form

Replace the existing Authorizing Officer for your organization

Group Administrator Change Request

Replace the existing Group Administrator for your organization

WCRB Group Administrator Web Account Registration

Complete to establish a WCRB website membership

Website Member User Guide

User Guide for WCRB website members and a listing of products afforded to each membership level

ACORD 134 WI

Wisconsin Supplementary Non-Election Form

ACORD 135 WI

Wisconsin Supplementary Election of Coverage Form

ACORD 136 WI

Wisconsin Supplementary Limited Other States Coverage Request

WI Pool V 1.0

Effective July 1, 2024, the Wisconsin Workers' Compensation Insurance Pool will no longer be accepting hard copy applications. Applications to the pool will only be accepted electronically via the Online Assigned Risk (OAR) member product. For more information on OAR, click here or contact our Pool Team at oar@wcrb.org or call 262-796-4592

WCPAP.ED11

WCPAP Premium Credit Factor Online Application

For assistance, please call 262-796-4593

WCPAP-ED02-16-17

WCPAP Carrier Audit Form

ACORD 101 (2008/01)

Additional Remarks Schedule

ACORD 130 (2017/05)

Workers Compensation Application

WC 00 00 00 C (Ed. 1-15)

Worker's Compensation and Employers Liability Insurance Policy language

WC 00 00 01 A - Information Page

Worker's Compensation and Employers Liability Insurance Policy information page

WC 00 00 01 A - General Information Page Notes

General Information Page Notes

WC 00 00 01 C - Information Page Notes

Information Page Notes