LHA Request

the loss history affidavit is a document that must be completed by the owner or officer of a company it serves to confirm whether employees have or have not experienced any work related injuries and whether any workers’ compensation claims have been reported additionally, it certifies that no current or former employee has reported an injury within the five years preceding the date the form is signed the loss history affidavit is a document that must be completed by the owner or officer of a company it serves to confirm whether employees have or have not experienced any work related injuries and whether any workers’ compensation claims have been reported additionally, it certifies that no current or former employee has reported an injury within the five years preceding the date the form is signed standard operational procedure on the left side bar, click on 'lha request' click on request lha