Workers’ Comp Forms
- Florida First Report of Injury (DWC-1): Complete this form within 24 hours of an accident or injury. When finished, fax to Normandy Harbor Insurance at 844-220-5070.
- Florida Wage Statement: Use this document to list an injured worker’s weekly earnings in the 91 days before the injury occurred. This document gives an overview of Florida state law regarding how employers should track and report the worker’s earnings history.
- Authorization for Medical Records/Reports: This form is to be signed by injured workers and gives Normandy Harbor Insurance permission to obtain their medical records for evaluation of their claim.
- Notice of Election to be Exempt
- Notice of Revocation of Election to be Exempt
- Workplace Safety Program
- Safety Credit Application Form
- Hotel/Motel Safety Program
- Hotel Safety Intro & Instructions
- Sections 1-10: Hotel Safety Program
- Sections 11: Blood Borne Pathogens
- Section 12: Lock Out Tag Out Program
- Section 13: Hazard Communication Program
- Section 14: Engineering Maintenance
- Section 14: Food and Banquet
- Section 14: Front Desk Administration
- Section 14: Housekeeping
- Restaurant Safety Program
- Hazard Communication Program
- Safety Ambassador 01 Brochure
- Safety Ambassador 02 Brochure
- Sharps Safety for Healthcare Professionals
- Workbook for Designing, Implementing and Evaluation a Sharps Injury Prevention Program