Last updated on Feb 20, 2026
OR-3271-WC free printable template
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The worker leasing company must also file a copy with the Oregon Workers Compensation Division and its insurer within 30 days after the final date of the lease arrangement or its knowledge that the client obtained other coverage. Worker Leasing Internal use only Termination Notice Cancels a client s proof of coverage Received date Approved Rejected A worker leasing company also known as a Professional Employer Organization PEO may terminate its obligation to provide workers compensation coverage...for a client by mailing a Termination Notice to the client. The worker leasing company may substitute its own form provided it meets the requirements under OAR 436-180-0110 3. ORS 656. 850 5 Please fax this notice to 503-947-7820. For other filing options call 503-947-7675. The worker leasing company is responsible to remove Notice of Compliance postings Form 1188 for all client worksites when the REQUESTED TERMINATION EFFECTIVE DATE Coverage end date for a client in Oregon Regardless of the...effective date above the termination will not be effective until the 30th day after the notice is received by the division or the effective date whichever is later. CLIENT INFORMATION provide ONLY client information in this section Business entity legal name FEIN do NOT use SSNs Assumed business name dba if any Client phone Oregon location address Client email if known or Home-based employees only Client mailing address if different REASON FOR TERMINATION Client relationship continues but Client...no longer has Oregon employees Nonpayment or other obligation not met Client now has client-purchased policy Client out of business retired or deceased Insurer name Changed PEO new PEO name if known Policy number Client changed FEIN new Form 2465 required Client left PEO unknown reason Other WORKER LEASING COMPANY INFORMATION Legal name dba if used in Oregon Oregon leasing license no. WLC000 Division hereby certifies that notice of this termination has been provided to the workers compensation...carrier and has been given by mail addressed to the client at its last-known address as required by OAR 436-180-0110 3 b. Authorized representative name please print Signature of authorized representative 440-3271 8/18/DCBS/WCD/WEB Email Phone Date. The worker leasing company may substitute its own form provided it meets the requirements under OAR 436-180-0110 3. ORS 656. 850 5 Please fax this notice to 503-947-7820. For other filing options call 503-947-7675. The worker leasing company is...responsible to remove Notice of Compliance postings Form 1188 for all client worksites when the REQUESTED TERMINATION EFFECTIVE DATE Coverage end date for a client in Oregon Regardless of the effective date above the termination will not be effective until the 30th day after the notice is received by the division or the effective date whichever is later. ORS 656. 850 5 Please fax this notice to 503-947-7820. For other filing options call 503-947-7675. The worker leasing company is responsible to...remove Notice of Compliance postings Form 1188 for all client worksites when the REQUESTED TERMINATION EFFECTIVE DATE Coverage end date for a client in Oregon Regardless of the effective date above the termination will not be effective until the 30th day after the notice is received by the division or the effective date whichever is later. CLIENT INFORMATION provide ONLY client information in this section Business entity legal name FEIN do NOT use SSNs Assumed business name dba if any Client...phone Oregon location address Client email if known or Home-based employees only Client mailing address if different REASON FOR TERMINATION Client relationship continues but Client no longer has Oregon employees Nonpayment or other obligation not met Client now has client-purchased policy Client out of business retired or deceased Insurer name Changed PEO new PEO name if known Policy number Client changed FEIN new Form 2465 required Client left PEO unknown reason Other WORKER LEASING COMPANY...INFORMATION Legal name dba if used in Oregon Oregon leasing license no.
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What is OR-3271-WC
The OR-3271-WC is a form used for reporting work-related injuries or illnesses in Oregon.
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Who needs OR-3271-WC?
Explore how professionals across industries use pdfFiller.
OR-3271-WC is needed by:
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Employees who have suffered a workplace injury or illness
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Employers needing to document workplace incidents
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Workers' compensation insurance providers
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Health care professionals assisting injured workers
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Legal representatives of injured employees
Detailed Guide to OR-3271-WC Form on pdfFiller
How to fill out the OR-3271-WC form?
Filling out the OR-3271-WC form efficiently is crucial for worker leasing companies in Oregon to maintain compliance with the state's Workers Compensation Division regulations. This guide provides step-by-step instructions to ensure you complete the form correctly.
Understanding the OR-3271-WC termination notice
The OR-3271-WC Termination Notice serves as a formal communication for employer-employee relationships that are ending. It highlights the importance of timely filing as per Oregon Workers Compensation Division regulations, helping to avoid potential legal repercussions.
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A notification to inform the Workers Compensation Division and stakeholders that a worker's compensation relationship has been terminated.
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Submitting the OR-3271-WC form promptly helps prevent disputes and ensures compliance with state laws.
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Failing to file the termination notice properly can result in fines or complications in future claims.
What are the step-by-step instructions for completing the termination notice?
Completing the termination notice involves accurately filling out essential client information along with the reason for termination. Each section must be approached with attention to detail to avoid delays in processing.
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Ensure that the client's name, FEIN (Federal Employer Identification Number), and contact details are accurate to avoid any issues later.
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Use the exact legal names as they appear on the client's business documents to maintain consistency.
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Choose the appropriate reason for termination from the provided options to align with compliance requirements.
How can you navigate compliance requirements in Oregon?
Understanding compliance regulations is crucial for successfully filing the OR-3271-WC form. Familiarity with Oregon Administrative Rules (OAR) and Oregon Revised Statutes (ORS) fosters compliance and reduces the risk of legal complications.
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Be aware of regulations that govern the termination process for worker leasing companies.
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Ensure notices are filed both with the division and the insurer to fulfill statutory requirements.
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Timely submission is essential to avoid fines; be mindful of deadlines set by state regulations.
What are the frequently encountered reasons for termination?
A variety of reasons can lead to the completion of an OR-3271-WC notice. Understanding these reasons can help confirm the legitimacy and appropriateness of the termination.
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When services are no longer needed, providing a termination notice is essential.
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If a client secures alternative worker's compensation coverage, a termination notice is necessary.
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Termination can be enacted if the client fails to meet their financial commitments.
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In cases where the client ceases operations or retires, the form must be filed.
How does pdfFiller simplify your document management?
pdfFiller enhances the process of managing the OR-3271-WC form through intuitive online tools. Its functionalities allow users to edit, eSign, and collaborate seamlessly on essential documents.
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Easily edit the OR-3271-WC form online to ensure accuracy before submission.
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pdfFiller's platform allows multiple users to collaborate on document preparation.
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Users can access previous submissions and templates from any location, ensuring convenience.
What are post-filing responsibilities for worker leasing companies?
After submitting the OR-3271-WC form, it’s crucial to fulfill remaining obligations. This includes taking down any postings that are no longer relevant.
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Once the termination notice is filed, remove all Compliance postings from client worksites.
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Be aware of any continuing responsibilities tied to the client's worker's compensation situation.
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Keep records of submitted notices for audits and future compliance checks.
How to fill out the OR-3271-WC
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1.Access the OR-3271-WC form on pdfFiller or download it from the official website.
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2.Begin by entering the employee's personal information, including name, address, and contact details.
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3.Specify the date and time of the incident, as well as the location where it occurred.
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4.Provide a detailed description of the injury or illness, including the mechanism of injury and immediate symptoms.
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5.List any witnesses to the incident along with their contact information, if applicable.
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6.Indicate whether medical attention was sought and include the name of the treating facility or doctor.
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7.Attach any supporting documentation or evidence regarding the incident, if available.
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8.Review the completed form for accuracy and completeness.
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9.Sign the form and provide the date of submission.
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10.Submit the form to your employer, insurance provider, or the appropriate regulatory agency as required.
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