Text Size:   A+ A- A   •   Text Only

    Reg Gregory   
503-947-7665   

Request for employer coverage information

If you want to identify an employer’s insurer, fill out and submit this on-line form. The Workers’ Compensation Division will reply with coverage information as requested.

Requester’s e-mail address (required): 
Employer’s doing-business-as name: 
Employer’s legal name: 
Employer’s street address: 
Employer’s city: 
Time period or date of coverage needed: 
 

Comments:


If you have questions about this webpage, please contact Reg Gregory, 503-947-7665.