Tennessee workers compensation forms: Fill out & sign online

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Click ‘Get Form’ to open the Tennessee Workers Compensation form in the editor.
Begin by entering your FEIN Number, Business Name, and Street Address in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in your City, State, and Zip Code. Next, print the name of the sole proprietor or partner responsible for the business.
Input your Social Security Number and provide your signature to affirm that you are a sole proprietor or partner acting as a sub-contractor opting out of coverage.
Complete the date fields and ensure that you have a notary public sign off on your affirmation. This step is essential for legal validation.
For the general contractor section, repeat similar steps: enter their FEIN Number, Business Name, and address details. The general contractor must also sign and date this section.
Finally, follow the instructions to submit the original form to the Workers' Compensation Division and distribute copies as required.

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