Permanent Authorization
Download: AC-2_Permanent Authorization

Temporary Authorization to Review Information (AC-3)
Download: 2012 – 2013 CareWorks Consultants 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 TT

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 Physician’s Report

Application for the One Claim Program
Download: OCP1 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