Family Assistance

Request Assistance

Submit a preliminary assistance request after a fatal work-related construction accident.

Preliminary Request

Aid To Family / Assistance Request Form

This preliminary request must be received within six months of a fatal work-related construction accident for consideration. Additional information may be required before financial benefits can be provided.

Before starting the request

Complete the form for the employee's spouse and legal beneficiary. Construction Angels verifies employment after the preliminary form is completed.

Questions may be directed to Kristi@ConstructionAngels.us or 954-274-6633.

Required field

1 Person completing the form

First name of person completing form

Last name of person completing form

Phone of person completing form

Email of person completing form

2 Decedent and legal beneficiary / spouse

First name of decedent

Last name of decedent

First name of spouse or legal beneficiary

Last name of spouse or legal beneficiary

Family / relationship

Primary language of spouse or children (if other than English)

Beneficiary phone

Beneficiary email

Street address

City

State

ZIP code

Children under 19 (include names and ages)

Submission details are available only to authorized Construction Angels administrators.

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Request Assistance

Aid To Family / Assistance Request Form

Is the company part of any of these associations?