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Brochures, Forms & Posters

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90 Day Reporting Requirement – Notification of Change in Ownership Endorsement

Document#:

WC 00 04 14 A

Edition:

01-01-2019

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Forms

All-in-One Broken Arm Poster - English

Document#:

DFS-F4-1548

Edition:

03-2010

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Posters

All-in-One Broken Arm Poster - Spanish

Document#:

DFS-F4-2026

Edition:

03-2010

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Posters

Alternate Employer Endorsement

Document#:

WC 00 03 01 A

Edition:

02-15-1989

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Forms

An Employers Guide to a Drug-Free Workplace

Document#:

​

Edition:

09-2020

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Brochures

Application for Drug-Free Workplace Premium Credit Program

Document#:

09-01A

Edition:

11-2019

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Forms

Certification of Employer Workplace Safety Program Premium Credit

Document#:

09-3A

Edition:

11-01-2019

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Forms

Defense Base Act Coverage Endorsement

Document#:

WC 00 01 01 A

Edition:

04-01-1992

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Forms

Designated Workplaces Exclusion Endorsement

Document#:

WC 00 03 02

Edition:

04-01-1984

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Forms

Domestic and Agricultural Workers Exclusion Endorsement

Document#:

WC 00 03 15

Edition:

04-01-1984

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Forms

Experience Rating Modification Factor Endorsement

Document#:

WC 00 04 03

Edition:

04-01-1984

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Forms

Federal Employers Liability Act Coverage Endorsement

Document#:

WC 00 01 04 A

Edition:

10-01-2004

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Forms

Federal Mine Safety and Health Act Coverage Endorsement

Document#:

WC 00 01 02 B

Edition:

01-01-2015

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Forms

Florida Workers Compensation Application

Document#:

130-FL

Edition:

07-19

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Forms

Florida Benefits Deductible Endorsement

Document#:

WC 09 06 05

Edition:

07-01-1990

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Forms

Florida Coinsurance Endorsement

Document#:

WC 09 06 04

Edition:

07-01-1990

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Forms

Florida Coinsurance and Deductible Endorsement

Document#:

WC 09 06 03

Edition:

07-01-1990

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Forms

Florida Contracting Classification Premium Adjustment Endorsement

Document#:

WC 09 04 01

Edition:

06-01-1987

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Forms

Florida Contracting Classification Premium Adjustment Program Workers Compensation Premium Credit Application

Document#:

09-4E

Edition:

11-01-2019

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Forms

Florida Employee Leasing Company Client Company Direct Workers Inclusion Endorsement

Document#:

WC 09 03 14

Edition:

07-01-2007

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Forms

Florida Employee Leasing Company Client Company Exclusion Endorsement

Document#:

WC 09 03 11

Edition:

07-01-2007

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Forms

Florida Employee Leasing Company Exclusion Endorsement

Document#:

WC 09 03 12

Edition:

07-01-2007

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Forms

Florida Employee Leasing Company Extension Endorsement

Document#:

WC 09 03 10

Edition:

07-01-2007

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Forms

Florida Employers Liability Coverage Endorsement

Document#:

WC 09 03 03

Edition:

08-01-2005

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Forms

Florida Employment and Wage Information Release Endorsement

Document#:

WC 09 06 06

Edition:

10-01-1998

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Forms
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