Must be posted in one or more conspicuous places at each insured location.
It is recommended to also post the Spanish version if there are employees that only speak Spanish.
Both versions are contained the above attachment. Filling in the English version will complete the Spanish version.
The box at the top of the form is for the Insured’s name and location. Complete the date and policy number. Select the Workers’ Compensation Insurance Company from the drop down box near the bottom of the page prior to printing.