Get Form Chswc 1

Filling out the Form Chswc 1 is an important step for insurers to report their contributions to the Workers’ Occupational Safety and Health Education Fund. This guide offers clear instructions to help you complete the form accurately and submit it online.

Follow the steps to successfully complete and file Form Chswc 1 online.

1. Click the ‘Get Form’ button to access the document and open it in the designated editor.
2. In the first section labeled 'Name of Insurer(s)', list all insurer names used to write workers’ compensation insurance in California. Be sure to provide a copy of each insurer’s Certificate of Authority issued by the California Department of Insurance. If needed, attach additional pages.
3. Complete the 'Company Officer' section by providing the name of the individual authorized to establish the program for loss control consultation services. Include their signature, printed name, title, and contact information for future correspondence.
4. For the 'Fee Calculation' section, indicate the total amount of paid indemnity claims reported for the prior calendar year. Multiply this amount by 0.0286% to determine the fees due. Ensure to attach a check payable to the Workers’ Occupational Safety and Health Education Fund for the greater of $100 or the calculated fee.
5. If you have questions while filling out the form, you can reach out via the provided contact number or email. Once completed, ensure that your report, the previous year’s Claim, Certificates of Authority, and payment are mailed to the specified address.
6. Finally, after reviewing your entries for accuracy, save your changes, and prepare to print, download, or share the completed form as required.

Complete your Form Chswc 1 online today to ensure compliance and contribution!