Employer Forms

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Endorsements

Endorsements Acceptable in Wisconsin

Standard endorsements accepted in Wisconsin

Endorsements N/A in Wisconsin

Listing of endorsements not accepted in Wisconsin

Reporting and Miscellaneous Requests

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

Hardcopy 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

WCRB Web Membership

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 Web site membership

Web Site Member User Guide

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

Wisconsin Worker's Compensation Insurance Pool

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

Wisconsin Worker's Compensation Insurance Pool hard copy application

Wisconsin Contractors Premium Adjustment Program (WCPAP)

WCPAP.ED11

WCPAP Premium Credit Factor Online Application

For assistance, please call 262-796-4593

WCPAP-ED02-16-17

WCPAP Carrier Audit Form

Worker's Compensation and Employer's Liability Policy

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