First Aid and Medical Services Checklist
Is there a hospital, clinic, or infirmary for emergency [...]
Is there a hospital, clinic, or infirmary for emergency [...]
SAMPLE INITIAL CHECKLIST Please complete a copy of this form [...]
Employers are required to make, keep, and preserve records pertaining [...]
Please complete a copy of this form for each FMLA-qualifying [...]
Most employers assume that if they give an employee 12 [...]
EXECUTIVE EXEMPTION To qualify for the executive employee exemption, all [...]
HAZARD ASSESSMENT Are any of the following eye and face [...]
ARE YOU MAXIMIZING EFFORTS TO REDUCE YOUR WORKERS’ COMPENSATION COSTS? [...]
Name: ______________________________________________ Date: _____/_____/_____ Position(s)? ________________________________________________________________ We would appreciate it [...]
Instructions: This form is to be completed by the supervisor [...]
Overview <FULL COMPANY NAME> (hereafter “<SHORT COMPANY NAME>”) establishes this [...]
I, _________________________________________________________________, hereby request a leave for FMLA. Please print [...]
(Include in termination package or obtain during exit interview) To: [...]
Please complete the following survey. The purpose of this survey [...]
Employee Name:______________________________________________________ Date: _____/_____/_____ Please print Name of Candidate you [...]
A variety of federal regulations - most notably those designed [...]
THE FOLLOWING ITEMS SHOULD BE KEPT IN A BASIC PERSONNEL [...]
Employee Name: ____________________________________________________ Effective Date: _____/_____/_____ Change: (check appropriate reasons) [...]
I elect to enroll in the Premium Payment Plan and [...]
EMPLOYEE INFORMATION Employee's Name _________________________________________________________________________ Employee’s Job Title: _________________________________________________________________________ INCIDENT [...]
Disability discrimination occurs when an employer or other entity covered [...]
Name of employee requesting accommodation: ___________________________________________________________Please print Name of individual [...]
Employee Name: __________________________________________________________ Dates Requested: __________________________________________________________ Reason for Request: ________________________________________________________ [...]
Overview <FULL COMPANY NAME> (hereafter “<SHORT COMPANY NAME>”) establishes this [...]
[ ] I hereby consent to a criminal background check [...]
Phone Number: 800.774.2755
Fax: 800.326.2864
Email: support@coactionspecialty.com
Coaction Specialty Insurance
412 Mount Kemble Ave.
Morristown, NJ 07960
Report the loss as soon as possible to claims@coactionspecialty.com or call 800.774.2755 (Option #1 for reporting a new claim, Option #2 for all other existing claims).
Immediately. When filing a claim, notify Coaction by contacting us either via email at claims@coactionspecialty.com, by phone at 800.774.2755 (Option #1 for reporting a new claim, Option #2 for all other existing claims) or fax 800.326.2864.

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