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Workers Compensation
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Workers Compensation
When did you start your business?
Brand new venture or Started earlier this year
Started last year
Started 2 years ago
Started 3 years ago
Started 4 years ago
Started 5 years ago
Started 6 years ago
Started 7 years ago
Started 8 years ago
Started 9 years ago
Been around a while started 10 or more year ago
How is your business structured?
Corporation
Partnership
Individual/Sole Proprietor
Sub-Chapter Corp
Limited Liabilty Co. (LLC)
Do any employees only do general office work and rarely travel?
Yes
No
Please provide the total number of claims (Lost Time or Medical) in the past three years (enter 0 if none)
0
1
2
3
4+
Do you currently have a Workers Compensation insurance policy in effect?
Yes
No
Do you use any volunteers or donated labor?
Yes
No
Do you have multiple locations in more than one state?
Yes
No
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