|OhioBWC - Employer - Form: (R-1) - Authorization of Representative of Employer|
|Authorization of Representative of Employer
|Employers and their representatives use this form to notify BWC of the employer’s authorized representative. Once the employer signs the form the named representative can act as the employer’s agent in the specified claim.|
- Representative's name, mailing address, including city, state, and ZIP code
- Representative's phone number
|Complete the forms|
The free Adobe Reader
software is required to display and print the application.
Do you have all the required information at hand? If so, you are ready to begin completing the form. When completing the online form, please use the previous and next buttons located at the bottom of the page to navigate through the form.
Begin online form now.
Are you missing some of the required information? If so, you may return here at a later time when you have all the information you need, and complete this online form. Or, you may print a blank copy of the form to complete by hand and either mail or fax it to BWC.
Print a blank form.