Get New York State Department Of Labor Workplace Safety And Loss Prevention Program State Office

Filling out the New York State Department Of Labor Workplace Safety And Loss Prevention Program form online can seem daunting, but this guide aims to simplify the process. By following the detailed steps outlined below, users can successfully navigate the form and submit their requests for evaluation or assistance.

Follow the steps to complete the online form effectively.

1. Click the ‘Get Form’ button to access the form and view it in the online editor.
2. In Section A, select the program(s) that you have implemented or plan to implement by checking the appropriate boxes for the Safety Program, Drug and Alcohol Prevention Program, and/or Return to Work Program.
3. Proceed to Section B, where you must indicate the services you are requesting. Choose one option: either that your company has already implemented the selected program(s) and requests evaluation, or that you need assistance in developing the program(s) and also want evaluation after implementation.
4. Complete Section C by providing your company's information. Fill in the required fields for company name, contact person, address, title, city, phone number, state, zip code, NAICS, e-mail address, number of employees, and FEIN.
5. In Section D, provide details regarding your Workers’ Compensation Insurance Information. Fill in all necessary fields, including insurer name, contact person, address, title, city, phone number, state, zip code, email address, annual policy renewal date, experience rating, annual insurance premium, and policy number.
6. In Section E, check all boxes to confirm that you are attaching the required documents. These documents include a list of all locations covered by the insurance policy, the number of employees at each location, a contact for each location, and a copy of your WSLPIP program documents if applicable.
7. Review the completed form carefully to ensure all fields are filled out accurately and all required documents are attached. When ready, submit the form as specified in the instructions to the New York State Department of Labor.
8. After the evaluation is completed and your program is established, remember to submit your application for the credit at least 120 days before your annual policy renewal date.

Ready to get started? Complete your request form online now to ensure a smooth evaluation process.