While you may be asked to complete a specific application or form, the information requested will typically be the same as we've listed below.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/for_the_feasibility_study.png)
For the Feasibility Study
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/FiveYearsBanner.png)
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/FeasibilityStudy-GraphIcon.png)
Workers' compensation claims data for the most recent five to ten years.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/FeasibilityStudy-DollarBagIcon.png)
Payroll data for the most recent five to ten years.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/FeasibilityStudy-HandIcon.png)
Workers' compensation premiums for the most recent five to ten years.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/state-self-insurance.png)
For the State Self-Insurance Permit
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/state-self-insurance-1.png)
Audited financial data for the past several years.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/state-self-insurance-2.png)
A general history of your firm or organization.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/state-self-insurance-3.png)
Information relative to the ownership of your firm.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/state-self-insurance-4.png)
Workers' compensation claims data for the most recent three to five years.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/state-self-insurance-5.png)
Information about your loss control program.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/state-self-insurance-6.png)
The names of your probable claims administrator and excess workers' compensation insurer.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ClaimsAdmin-MainIcon.png)
For The Claims Administrator / Service Company
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ClaimsAdmin-1.png)
Copies of actual workers' compensation claim printouts (called "loss runs") showing both the dollar amount of the claims and the number of claims.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ClaimsAdmin-2.png)
General information about your organization, including number of locations and employees, and size of payrolls.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ClaimsAdmin-3.png)
Information regarding your expectations for a loss control program and your desires for frequency of claims reports.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ClaimsAdmin-4.png)
Your desired involvement in the claims process, such as regular meetings to review large claims, etc.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ExcessWorkersSectionIcon.png)
For An Excess Workers' Compensation Underwriter
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ExcessWorkersIcon-1.png)
Seven to ten years prior workers' compensation and losses and premium, including your workers' compensation experience modification worksheets, if available. The insurance broker or TPA working with the excess underwriter(s) can help you prepare this information.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ExcessWorkersIcon-2.png)
Seven to ten years prior payroll data (insurance company audits are best) and have budgeted payrolls for the coming year.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ExcessWorkersIcon-3.png)
Details on any workers' compensation claim larger than $100,000.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ExcessWorkersIcon-4.png)
General information on your firm, its history, etc.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ExcessWorkersIcon-5.png)
Information on the use of any watercraft or any owned, leased, or chartered aircraft.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/ExcessWorkersIcon-6.png)
The name(s) of prospective claims service companies.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/BondUnderwriterIcon.png)
For The Bond Underwriter
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/BondUnderwriter-1.png)
Three years audited financial statements, plus interim financial statements for the current year.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/BondUnderwriter-2.png)
Banking references.
![Safety National Safety National](https://www.safetynational.com/wp-content/themes/SafetyNational-Light/images/infographic-svgs/BondUnderwriter-3.png)