Workers Compensation Construction Industry
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Company Name
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First Name
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Last Name
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Company Website
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Street
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City
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State
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AL
FL
GA
IL
KY
LA
MD
MI
MS
MO
NC
ND
NE
NJ
OH
SC
TN
TX
VA
WV
Postal Code
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Phone
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E-Mail
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Nature of Business
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Number of Full time employees
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Number of Part Time Employees
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Does the company work outside of Florida?
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Yes
No
How many years of construction experience does the owner have?
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Is this the owners first construction company? If no, list the others.
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Is this the owners first construction company? If no, list the others.
What other construction companies has the owner worked for in the past?
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Has this company, or any other companies that you have been affiliated with, ever received a stop work order from the state Division of Workers Compensation?
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Yes
No
Does the company have a business checking account?
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Yes
No
Describe the typical type of work/job this company performs.
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Describe the typical type of work/job this company performs.
What construction/business license(s) do the owners/officers currently hold or plan to obtain in the next 12 months?
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How many employees will be performing and/or supervising construction work?
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What is the average hourly wage the company pays its (hourly) workers?
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Does/will the company pay employees (full time, part time, or day laborers) partially or wholly in cash?
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Yes
No
How much payroll do you estimate the company will have in the next 12 months?
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How many support staff employees does the company have who are in sales and/or clerical only positions?
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Does the company file or plan to file a Florida Employer's Quarterly Report (RT-6 unemployment tax return) on all employees? If no, why?
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Yes
No
If the company uses subcontractors, does the company verify that all subcontractors have either a valid exemption from workers compensation or are covered by a worker's compensation policy?
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Yes
No
How much do you estimate the company will have in subcontractor labor costs this year?
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Describe the type of work that the company typically subcontracts.
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Describe the type of work that the company typically subcontracts.
What percentage of the company's work is residential?
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What percentage of the company's work is Commercial?
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What percentage of the company's work would be classified as a General Contractor?
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What percentage of the company's work would be classified as a subcontractor?
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What percentage of the company's work is
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Carpentry/Framing
Concrete/Masonry
Demolition
Electrical
General Contracting
HVAC
Interior trim
Misc. repair
Painting
Plumbing
Roofing
Site work
Tile
Wallboard/Drywall
What percentage of the work is from answers to the previous question?
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How many stories above ground does your company work?
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What type of vehicle is used in the course of the company's work?
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What is the longest distance you and the company's employees typically drive to jobsites?
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How many employees do you transport to jobsites?
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Does the company retain all job files?
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