Documents for Employers

Forms Downloads
Lapsed Coverage Forgiveness Form
The following BWC form can be used for the one-time forgiveness program for lapsed coverage.
AC-2 Permanent Authorization
The AC-2 is used to make a permanent assignment of an authorized representative to handle risk and claim issues on behalf of an employer.
PDF | Web
AC-3 Temporary Authorization to Review Information
The AC-3 provides a limited authorization for the TPA to review an employer’s risk and claim files, experience data, and other associated information.
PDF | Web
C-55 Salary Continuation Agreement
This form is used to acknowledge an agreement to pay salary/wage continuation in lieu of temporary total or living maintenance compensation.
 Notification of Business Acquisition/Merger or Purchase/Sale
An employer must complete the U-118 when succeeding another business in whole or in part for the purposes of transferring experience.
Transitional Work Bonus Program Application
This form is used to apply for a bonus of up to 10% of employer’s pure premium based on the success of the transitional work program utilized on eligible claims with dates of injury within enrolled bonus period.

Useful Links

Prospective Billing Changes from the BWC
Another Billion Back FAQ
Comprehensive list of Commonly Used BWC Forms
Ohio Industrial Commission
Occupational Safety & Health Administration