February 20, 2018

Online Forms

Wage Continuation Statement C-94-A - Form to have employee sign to continue to pay wages in lieu of compensation by the Ohio BWC

Settlement Agreement C-240 – Form to settle claims with claimant

Employer Authorized Representative R-1 - Form to have attorney representation at hearings before The Industrial Commission of Ohio

2011 Base Rates – Current Base Rate for the 7-1-11 rating year

Temporary Authorization to Review Information AC-3 – Application to review your company for our group rating program

First Report of Injury, Occupational Disease or Death FROI – First report of injury form

Waiver of Appeal Period C-108 – Form to wave the appeal period

Wage Statement C-94-A – Wage statement form for employer

Instructions for Completing the Motion C-86 – Blank form to file a motion with BWC

Notification of Policy Update U-117 – Form to update current change of address or ownership for the employer’s policy