Premium Audit Checklist

• Description of your business operations
• List of business location(s)
• List of owner/officers and their job responsibilities
• List of employee names and description of work performed (not job titles)

• Payroll records for W-2 employees (system generated report for the policy period)
• Federal 941 or California DE9c preferred (quarters should match or overlap policy period). If a 941 is not available: Form 940, W-2, or W-3 can be used if the policy period runs for a calendar year.
• Payroll summary needs to include the following items:
  • Employee Name
  • State where work is performed
  • State where work is performed
  • Gross wages per individual
  • Overtime*
  • Double-time*
  • Tips: Excess tips above federal minimum wage may be excluded in Delaware and Pennsylvania, those above state minimum wage may be excluded in Vermont
  • Section 125 Cafeteria Plan (Employee Contribution & excludable only in California)
  • Furloughed wages (wages paid for not working during Covid-19 pandemic)

For California construction policies, timecards showing clock in and clock out times are required, as well as a payroll report showing hourly pay rates.

• Payroll records for use of 1099 labor
  • Preferred: Vendor Summary Report
  • Form 1099 or Form 1096 can be used for calendar year policies
• Contracted labor information
  • Contract labor or subcontractor name
  • Description of work performed
  • State in which work was performed
  • Date work started and stopped
  • Total amount paid
  • Total amount paid for materials
  • Workers’ Compensation Certificate of Insurance (COI) for Subcontractors (If no workers compensation COI can be provided, additional tests of independent status may apply in order to exclude subcontractors.)
• Certified payrolls on OCIP/CCIP jobs
• Additional information that may be requested
  • Profit and Loss Statement
  • General ledger and check register
  • Cash disbursement

* Not excludable in Delaware, Pennsylvania, or Nevada.