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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.

Required information
  • Representative's name, mailing address, including city, state, and ZIP code
  • Representative's phone number

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