Florida Workers Compensation Forms



Form #		Description of Form

DWC-1		First Report of Injury or Illness

DWC-1a		Wage Statement

		Drug-Free Workplace Credit Application

		Employer Workplace Safety Program Credit Application

		Florida Contractors Premium Credit Application

		Florida Contractors Premium Credit Instructions

BCM-250		Notice of Election to be Exempt

BCM-250-R		Revocation of Election to be Exempt

BCM-251		Notice of Election of Coverage

BCM-251-R		Revocation of Election of Coverage

BCM-250 Instructions		Instructions for completing Construction Industry Application for Exemption (Notice of Election to be Exempt LES Form BCM-250)

BCM-250 Instructions		Instructions for completing Non-Construction Industry Application for Exemption (Notice of Election to be Exempt LES Form BCM-250)

ERM 14		Change of Ownership

		Medical History Questionnaire English/Spanish

		Personal Protection Equipment Agreement

215 East Main Street Bartow, FL 33830
800.330.4745 FAX: 863.534.3562
E-mail: frank@workcomppartners.com