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Safety committee certification

Libc 372 form 2026

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The document is an Initial Application for Safety Committee Certification (LIBC-372) used by employers in Pennsylvania to certify their workplace safety committees under the Workers' Compensation Act. It outlines the necessary information and requirements for certification, including details about the organization, committee structure, workers' compensation policies, eligibility criteria, member training, and responsibilities of the safety committee. The application aims to ensure that all workplaces associated with a Federal Employer Identification Number (FEIN) are represented by valid safety committees to qualify for potential discounts on workers' compensation insurance.

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Click ‘Get Form’ to open the libc 372 form in the editor.
Begin with Section 1, where you will enter your organization’s primary business name, Federal Employer Identification Number (FEIN), and contact details. Ensure all fields are completed accurately to avoid processing delays.
In Section 2, select the appropriate committee structure type: Single, Centralized, or Multiple. This choice is crucial for determining eligibility for discounts.
Proceed to Section 3 to document all FEINs associated with your organization. Each FEIN must be unique and listed only once.
In Section 4, provide details of your current workers’ compensation insurance policies. Ensure that each policy number is unique and corresponds correctly to the FEINs listed.
Complete Section 5 by detailing each workplace's address and linking it to the corresponding FEIN and insurance policy numbers.
Continue through Sections 6 to 11, providing information about safety committee eligibility, member training, responsibilities, and meeting records as required.
Finally, review Sections 12 and 13 for effectiveness measures and acknowledgments before submitting your application.

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2017	4.8 Satisfied (62 Votes)

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