Text Size:   A+ A- A   •   Text Only

    Linda Repp   

Employer coverage request form

If you want to identify an employer’s insurer, fill out and submit this online form. The Workers’ Compensation Division will reply with coverage information as requested.

Requester’s email address (required):  
Employer’s "doing-business-as" name:  
Employer’s legal name:  
Employer’s street address:  
Employer’s city:  
Time period or date of coverage needed:  


If you have questions about this webpage, please contact Linda Repp, 503-947-7664.