Workers comp
Flexible workers comp
Short - term coverage
Pay-as-you-go plans
PEO services
Fast staff management
About OCMI
Who we are?
Compliance
Compliance with requirements
Contact us
Connect with us
Workers comp certificate request
Get your proof of coverage with ease
Clients forms
Filling forms for your needs
Help center
Need assistance? Start here
Blog
Business insights & resources
Payroll calculator
Hourly paycheck calculator
OCMI App
Submit hours, onboard new employees
FAQ
Frequently asked question
Short-term coverage
Clients forms
Payroll calculator
Recurring Payment Authorization
Client Authorization to Debit/Credit
Direct Deposit
Client Affidavit Of Zero Wages
Separation Notice
Workers Comp Claim Kit
SEPARATION
NOTICE
FORM
Is your employee no longer with the company or no longer needs Workers Comp insurance through your company? Complete this form to remove the employee from your Workers Comp program.
Important:
If this is a temporary separation or if you expect the leased employee to return to work for you, do not complete this form.
Question #1
Is employee eligible for re-hire with Client?
Question #2
Did employee sign a separation and release agreement?
Question #3
Upon separation did you report or will you be reporting payroll wages for the employee?
(Note: Wages must be reported to your Payroll Specialist.)