Ohio Bureau of Workers' Compensation Forms

This form is used for submitting an application for elective coverage in Ohio.

This Form is used for opting out of the .99 Em Construction Cap in Ohio.

This Form is used for public employer state agencies in Ohio to apply for the Lump Sum Settlement (LSS) Direct Reimbursement Rating and Payment Program.

This Form is used for submitting a Sponsor Certification Application in Ohio. It is necessary for individuals or organizations who wish to sponsor a foreign national for certain visa categories.

This form is used for conducting a pre-audit questionnaire in Ohio.

This form is used for applying for the Deductible Program in the state of Ohio.

This document is used for reporting the work ability of individuals with cognitive or psychological conditions in the state of Ohio. It is filled out by physicians on the Disability Evaluator Panel.

This form is used for summarizing mental health notes in Ohio, specifically for non-psychotherapy notes.

This form is used for medication physician review in Ohio. It is specifically related to the Ohio Bureau of Workers' Compensation (BWC) and is known as Form MEDCO-22 or BWC-3922.

This document is used for creating a rehabilitation agreement in Ohio. It is a form that outlines the terms and conditions for the rehabilitation process.

This Form is used for the Certification Agreement between an injured worker and a service provider (contractor) in Ohio.

This Form is used for Managed Care Organizations (MCO) in Ohio to request Drug Utilization Review (DUR) services from MEDCO-34 (BWC-3934).

This form is used for loaning or releasing tools and equipment in the state of Ohio.

This form is used for creating a work trial agreement in Ohio. It helps employers and prospective employees outline the terms and conditions of a trial period before official employment.

This form is used for applying for accrued compensation in the state of Ohio.

This type of document is a consent form used in Ohio (Spanish) to authorize the disclosure of information.

This Form is used for reporting earnings to claim Living Maintenance Wage Loss Compensation in Ohio.