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
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
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