OhioBWC - Employer: (List of Self-Insuring Forms Available For Download) | ||||
|
Self-insuring forms |
||
Initial Application by Employers for Authority to Pay Compensation Etc. Directly (SI-6) | View/Print | Instructions |
Example: Organization structure for initial application | View/Print | |
Agreement Between Employer and the Ohio Bureau of Workers' Compensation Regarding Amount of Self-Insured Buyout (SI-16) | View/Print | Instructions |
Contract of Guaranty (SI-38) | View/Print | Instructions |
Permanent Authorization (AC-2) | View/Print | Instructions |
Rehabilitation Election (SI-8) | View/Print | Instructions |
Handicap Reimbursement Election (SI-41) | View/Print | Instructions |
Election to Withdraw from Claims Reimbursement Fund (SI-44) | View/Print | Instructions |
Medical management criteria for self-insurance | View/Print | |
Self-Insured Public Employer Questionnaire | View/Print |