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Ohio Workers Compensation Forms

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OH FORMS

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Please feel free to download and use our forms and documents from our free forms library.  We make every effort to keep our forms and documents updated with the most recent versions for your convenience.

Ohio operates is a monopolistic state fund.  It is part of a state controlled workers compensation plan.  The state does not allow private insurance carriers to provide policy coverage in this state and therefore we do not offer any forms at the present time.

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 OH Comp Forms

 

Ohio Workers Compensation Forms

Ohio Acord 130 Workers Compensation Application

The standard Acord 130 application form for workers comp coverage in Ohio.

Ohio First Report of Injury Form

First Report of Injury Form.  Employers should complete this form and send to their insurance company each time an injury occurs.

Ohio Application for Exclusion of Officers and Stockholders

Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.

Ohio Application for Exemption for Workers' Compensation Insurance

Complete this form if you are a sole-proprietor, partnership with no employees or an officer of a corporation and would like to be exempt from coverage.

Ohio Application for Deductible Program

Complete this form is you wish to apply for the Ohio Deductible Program.

Apprenticeship Elective Coverage Contract

Contract for apprentices to elect coverage.

Apprenticeship Elective Coverage Contract

Contract for apprentices to elect coverage.

Application for Permanent Authorization

Complete this for to give authorization to an Employer risk claim representative, Risk management representative, or Claim management representative.

Claim Reimbursement Withdrawal Form

Complete this form to elect to withdraw from the claims reimbursement fund, thereby withdrawing the employer from participation in the claims reimbursement portion of the surplus fund.

Ohio Employer Incentive Program

Complete this form to apply for the Ohio Incentive Program.

Handicap Reimbursement Election Form

complete this form if you are self-insured and wish to elect to withdraw from the handicap reimbursement program.

Election to obtain coverage in other states

Complete this form if you are planning to obtain insurance in another state.

Self Assessment Business Plan for Safety

Complete the self-assessment to show us how you met the requirements of the 10-Step Business Plan for Safety.

Opt Out of .99 EM Construction Cap Program

Complete this form if you meet the requirements and wish not to participate in the .99 EM Construction Cap Program.

Ten Step Business Plan of Action

Complete this form to present your business plan to the Ohio Bureau of Workers' Compensation.


State Resources for Ohio

State of Ohio

www.ohio.gov/

Ohio Bureau of Workers’ Compensation

www.ohiobwc.com/
30 West Spring Street
Columbus, Ohio 43215-2256
(800) OHIOBWC (800-644-6292)

Industrial Commission of Ohio
www.ohioic.com/index.jsp
30 West Spring Street
Columbus, Ohio 43215-2256
(800) 521-2691

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