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OhioBWC - Employer - Form: (Accident report) - Details

DFSP Accident Report (DFSP-1)

Introduction
BWC requires employers in the Drug-Free Safety Program to perform an accident analysis for each approved workers' compensation claim that occurs while the employer is in the program. Employers should perform the analysis as soon as possible after the accident. This form helps the employer summarize the accident analysis for reporting purposes. The employer must complete and submit this report to BWC within 30 days of an approved claim.


Required information
  • Employer name
  • Policy number
  • Employee name
  • Date of Injury
  • Claim number
  • Name of person completing report
  • Job title of person completing report
  • Manner of accident
  • Accident description
  • Causal factors
  • Preventative measures description
For step-by-step instructions on completing the form, watch this online tutorial.
Note: Flash player required

If you have all the required information on hand, simply click the start button to begin.

Start

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