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OhioBWC - Employer:  (Instructions for the completion of the Rehabilitation Election (SI-8))

Instructions for the completion of the Rehabilitation Election

(SI-8)

If your firm decides to pay rehabilitation costs directly per the parameters indicated on the form, then complete the following form and include with the remainder of the packet of requested information. This election is irrevocable, once it is made.
  1. Company Name: Enter your company as it appears in the articles of incorporation.
  2. Signature: A person authorized to sign for your company should sign the form.
  3. Title: Enter the title of the person signing the form.
  4. Date: Enter the date that the form was signed.
Print Rehabilitation Election Form (SI-8)


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