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Employer resources Calculating Premium Reporting Payroll Experience Modifiers Payroll Audits Employment Policies claims Reporting Claims Claims Tips Preventing Fraud Loss Control Site Visits Safety Programs ONLINE FORMS Underwriting Claims Employers News Find an Agent Contact Us >> Home	SECOND INJURY FUND QUESTIONNAIRE Personnel records which include prior medical histories – to be completed after an offer of employment has been made - are extremely helpful in assessing eligibility of Second Injury Fund recoveries. FOR LOUISIANA EMPLOYERS: Second Injury Fund Questionnaire (PDF) Second Injury Fund Questionnaire (Word) Second Injury Fund Questionnaire (in Spanish)	Employer Downloads First Report of Injury Claims Reporting Guide Second Injury Questionnaire Employment Documents Fraud Guide and Poster Safety Program Components Safety Tips and Checklists OSHA Recordkeeping UNDERWRITING DOWNLOADS Underwriting Guide ACORD Application Contractor Supplemental #210 Owner/Officer Exclusion #211 Convenience Store #212 Automobile Exposure #213 Trucking Supplemental #214 ERM-14 Change in Ownership Policyholder Address Change Cancellation Request You will need to have Adobe Acrobat Reader version 7.0 or higher software to view these .PDF files on your computer. If you do not have the latest Adobe Acrobat Reader, click the icon to visit the Adobe website to download a free copy of Adobe Acrobat Reader.
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