Ohio Bureau of Workers' Compensation Forms

This document for workers in Ohio who want to waive their worker's compensation benefits in order to participate in recreational or physical activities.

This form is used for self-insured employers in Ohio to certify the assignment after the initial allowance. It is necessary for employers to provide this certification to ensure proper handling of workers' compensation claims.

This form is used for State Fund employers in Ohio to agree to accept a claim assignment.

This Form is used for requesting corrections to employer and/or policy number assignments in Ohio.

This Form is used for providing notice of intent to settle a case in Ohio. It is also known as Form C-512 (BWC-1488).

This Form is used for applying for an adjudication hearing in Ohio.

This form is used for settling claims against employers in Ohio who have failed to comply with workers' compensation requirements.

This Form is used for applying for a Representative Identification Number (RIN) in Ohio. RINs are required for representatives who will be electronically filing documents on behalf of clients with the Ohio Bureau of Workers' Compensation (BWC).

This Form is used for the Employer Incentive Contract in Ohio.

This form is used for self-insured employers and injured workers in Ohio to conduct screening for the Statewide Disability Evaluation System.

This Form is used for submitting the initial report of a work-related injury, occupational illness, or death in Ohio.

This Form is used for submitting the Division of Safety & Hygiene Group Experience and Group-Retrospective Rating Safety Requirements Annual Report in Ohio.

This Form is used for applying for adjustment of a claim in Ohio when the cause of death is an occupational disease.

This Form is used for applying for the industry-specific safety program in Ohio. It is called form SH-28 (BWC-6627).

This form is used for an Unconditional and Continuing Guarantee in the state of Ohio. It ensures that the guarantor will fulfill their obligations even if the main party fails to do so.

This form is used for applying for a self-insured construction wrap-up program in Ohio. It is specifically designed for construction projects in which multiple contractors are involved and a single insurance policy covers the liability for all parties. This application helps the construction company apply for self-insured status and provides details about the project and the contractors involved.

This document is a form used in Ohio for subrogation referral related to workers' compensation claims. It is used when an employer or insurance carrier wishes to recover costs from a third party responsible for a work-related injury or illness.

This form is used for applying to the Workplace Wellness Grant Program in Ohio. It is designed to help employers promote health and wellness in the workplace.

This form is used for applying to the Transitional Work Bonus Program in Ohio. It is known as Form TWB-1 (BWC-3000).

This form is used for applying for reimbursement of self-insured claims by Sysco in Ohio.

This type of document is a job offer and acceptance form for transition in Ohio. It is written in Spanish.

This form is used for the Transitional Work Grant Agreement in the state of Ohio.