Get Form Hs-36-a - Arkansas Workers' Compensation Commission - Awcc State Ar

This guide provides a comprehensive overview of the Form HS-36-A used for the Arkansas Workers' Compensation Commission's Voluntary Drug-Free Workplace Program. It will assist users in effectively completing the form online, ensuring all required information is accurately provided.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Enter the company information. Fill in the company name, address (including city, state, and zip code), FEIN, and NAICS.
3. Provide the effective date of your drug-testing program and the company contact's information, including their telephone number, title, and email.
4. Specify the workers’ compensation insurance status, selecting either ‘Self-insured’ or ‘Purchase (WCI)’. Then, include the insurance carrier or third-party administrator details.
5. Indicate the average number of employees during the last calendar year by entering the full-time and part-time figures.
6. For the drug testing program, input the Program Manager or Third Party Administrator's information, including name, address, city, state, zip, telephone number, and email.
7. Enter the testing lab's details: name, address, city, state, zip, telephone number, and lab certification number (only one certification is necessary).
8. Attach a recent year-end summary report from your testing laboratory or a letter explaining why no tests were performed.
9. Complete the employer certification section by signing and dating the form to affirm that the provided information is true and accurate.
10. Notarize the form as required, then save your changes, download or print the completed form for submission.

Complete your document online to ensure compliance with the Arkansas Workers' Compensation requirements.