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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  

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