The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer.
WC-401A - Notice of Termination of Specific Risk Policy
This form is used to report termination of insurance coverage for an employer covered under a specified construction site insurance policy and is not available online. To obtain a copy of this form, contact the Compliance & Employer Records Division at 517-284-8922.