Meet the Experts
Risk Management Solutions
How Helpside Works
Helpside Company Tools Login
PrismHR Manager (MSS) Portal
Human Resources Library
Client Help and Support
Report a Work Injury
Employee Tools Login
2023 W-2s Now Available
Workers' Compensation Certificate Request
To request a copy of your workers' compensation certificate, please complete the form below.
Your first and last name
Requester Email or Fax Number
Your email or fax number
Requester Phone Number
Your phone number
Name of the company insured through the Helpside program
Name of company or party the certificate is to be sent to
Holder Address (Street, City, State and Zip)
Address of company or party the certificate is to be sent to
Person who's attention the certificate should be sent to
Holder Email or Fax Number
Email or fax of company or party the certificate is to be sent to
Additional Info (job site, job number, additional contract requirements, etc.)
If the certificate holder requires anything additional on the certificate, such as specific job listed, or specific wording, please list it here.
If holder has provided a list of insurance requirements, please attach document with this request.
Click or drag a file to this area to upload.
Where would you like the certificate sent? (Be sure to provide an email or fax above for each recipient selected.)
Request Work Comp Certificate