Workers compensation waiver 2025

1. Click ‘Get Form’ to open the workers compensation waiver in the editor.
2. Begin by entering the 'Insured Name' and 'Policy #' at the top of the form. This information identifies the insurance coverage related to the waiver.
3. Next, provide the 'Name and Address of 3rd party' from whom you are requesting the Waiver of Subrogation. Ensure accuracy for proper processing.
4. Fill in the 'Specific details of the Job', including 'Job number', 'Start Date', and 'End Date'. These dates help define the timeframe for which coverage is requested.
5. List specific operations that will be performed during this job. This section clarifies what activities are covered under this waiver.
6. Explain the scope of the project in detail, providing context for why this waiver is necessary.
7. Indicate the 'Specific Location of the job' by providing a complete street address, city or area, and state.
8. Enter total payroll for this specific job or ongoing jobs, along with the number of employees involved. This information is crucial for assessing risk and coverage needs.
9. Finally, specify who is responsible for safety controls on this project and describe what controls are in place to ensure safety compliance.

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