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Policyholder Forms
Florida Contracting Classification Premium
Adjustment Program Application (FCCPAP)
This program provides for a premium credit for up
to one year for a policy that contains one or more
contracting classification codes. Forms are to be
submitted directly to NCCI.
Application for Drug-Free Workplace
Premium Credit Program
Policyholders in Florida can qualify for a credit if they
have a drug-free workplace program in place. They
must complete this form and have it notarized to apply
for the credit.
Application for Employer
Workplace Safety Program Credit
Policyholders in Florida can qualify for a credit if they
have a safety program in place. They must complete
this form and have it notarized to apply for the credit.
ERM-14 (Name, Ownership or legal Entity change) Instructions on how to complete an ERM-14
Exemption/Revocation Forms
- DWC Instructions - Notice of Election to be exempt
- DWC 250 Notice of Election to be exempt
- DWC 250-R Notice of Revocation of Election to be
exempt
- DWC 251 Notice of Election of coverage
- DWC 251-R Revocation of Election of Coverage