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 31 State Forms found

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Report of Paid Compensation and Case Reserves

 BWC-7240 SI-40 (Rev. Oct. 23, 2023)

Request for Temporary Total Compensation

 BWC-1205 C-84 (Rev. Feb. 18, 2026)

Request for Temporary Total Compensation (Spanish)

 BWC-1205 C-84-ES (Rev. 21 de septiembre de 2023)

Salary Continuation Agreement

 BWC-1174 C-55 (Rev. Jan. 29, 2024)

Self-Insured Semiannual Report of Claim Payments

 BWC-1301 C-174 (Rev. Feb. 7, 2024)

Settlement Application for Non-complying Employer Claims

 BWC-3516 LEGAL-16 (May 21, 2024)

Notice to BWC of the Injured Worker and Employer Agreement and Authorization to Send Injured Worker's Check(s) to the Employer

 BWC-1123 C-18 (Rev. Dec. 13, 2023)

Wage Loss Statement for Job Search

 BWC-1268 C-141 (Rev. April 14, 2026)

Employer Report of Employee Earnings for Wage Loss Compensation

 BWC-1269 C-142 (Rev. Feb. 25, 2026)

Employer Report of Employee Earnings

 Wages-EMP (Sept. 22, 2023)

Initial Application by Employer for Authority to Pay Compensation Etc., Directly

 BWC-7206 SI-6 (Rev. Nov. 3, 2023)

Application for Accrued Compensation

 BWC-1198 C-6 (Rev. Dec. 11, 2023)

Report of Earnings for Living Maintenance Wage Loss Compensation

 BWC-3061 RH-94A (Rev. April 25, 2024)

EBT - Electronic Benefit Card Enrollment Application (Spanish)

 A-21-ES Rev. March 17, 2025

AGREEMENT AS TO COMPENSATION FOR PERMANENT PARTIAL DISABILITY

 ICGC1, OIC 3013 (Rev. 06/12)
Disclaimer: These forms may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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