Get N&d Self-audit Form - Massagent.com

This guide provides clear and detailed instructions on filling out the N&D Self-Audit Form online. Completing this form accurately is essential for ensuring proper audit and compliance with your workers’ compensation policy.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the N&D Self-Audit Form and open it in your chosen editor.
2. In the Policy Info section, enter the policy number, agent name, insured party, code, address, phone number, effective date, and the audit period specified.
3. Proceed to the Work Locations section. Fill out the location number, street address, city, state (abbreviated), and zip code for each work location.
4. Move to the Employee Payroll section. Enter the work location number, class code, class description, average number of employees, gross payroll (which includes total wages, bonuses, and commissions), and excess overtime where applicable.
5. Continue to the Owner, Officer, Partner, Member Payroll Info. Fill in the work location number, name, title, class code, class description, whether they are included in payroll, and their salary.
6. In the Independent Contractor Info section, provide the work location number, contractor name, description of work performed, the cost of subcontracted work, and indicate whether a Certificate of Insurance is available.
7. Finally, sign and print your name, title, and date at the bottom of the form.
8. Once all sections are complete, save your changes, then download, print, or share the completed form as necessary.

Complete your N&D Self-Audit Form online today to ensure compliance and accuracy.