Resources

Permanent Authorization

Download: AC-2_Permanent Authorization

Temporary Authorization to Review Information (AC-3)

Download: 2018-2019 CareWorksComp AC-3

Salary Continuation Agreement

This form is used to notify BWC that the employer and then injured worker have agreed to continue the injured worker’s salary while he/she is off worker for the injury.
Download: C-55 Salary Continuation

Request for Temporary Total Compensation

Use this form if you are an injured worker who wishes to request total compensation on a temporary basis.
Download: C-84 Request for Temporary Total Compensation

Wage Statement

This form is for the employer, unless the injured worker is self-employed or unemployed.
Download: C-94-A Wage Statement

First Report of Injury, Occupational Disease or Death

Download: FROI

Physician’s Report of Work Ability

This form provides the employer and then injured worker with important physician information regarding the injured workers’ ability to work and instructions to assist in the injured worker’s return to work.
Download: MEDCO-14 Physicians Report of Work Ability

Application for the One Claim Program

Download: OCP One Claim Program

Application for Drug-Free Safety Program

Download: U-140 Drug-Free Safety Program

Application for the Deductible Program

Download: U-148 Deductible Program

Application for Ohio Workers’ Compensation Coverage

Download: U-3 Application for WC Coverage


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