Forms and Information

Claims reporting requirements and loss forms can be found on this page. Please review all information and follow the procedures as described. Information contained on this page is in addition to following your entity's procedures for reporting and responding to an incident. You should alert local emergency authorities as appropriate.

Annual Renewal Information

All direct members and members of LAWCX JPA members are required to submit an annual Renewal Survey. The Renewal Survey will prompt you to answer questions regarding your agency’s operations, OSHA violations, and risk exposures.

icon-export  Ventiv – RiskConsole Website link  (best viewed in Chrome)

To assist members with navigating the online platform, use the documents guides below:

icon-doc  Risk Console User Guide – Renewal Survey Only – has multiple screen shots walking you through the program.

icon-doc  Risk Console- Quick Guide Renewal Survey – is a step-by-step guide.

icon-doc  Risk Console – Direct Member User Guide – is a step-by-step guide.

For assistance, Katie Achterberg.

Report a Claim

icon-export Report a WC Claim

Membership Form

icon-doc New Member Application

Monthly Data Submission

Every current and withdrawn member of LAWCX is required to submit loss data to LAWCX. Loss data is required to be reported monthly. Please view the specification documents.

icon-doc  Universal Electronic Loss Data Submission

icon-doc  Loss Data Specifications