Forms and Agreements

• Permanent Authorization
• Temporary Authorization to Review Information (AC-3)
• Salary Continuation Agreement
• Request for Temporary Total Compensation
• Wage Statement
• First Report of Injury, Occupational Disease or Death
• Physician’s Report of Work Ability
• Application for the One Claim Program
• Application for Drug-Free Safety Program
• Application for the Deductible Program
• Application for Ohio Workers’ Compensation Coverage

Private Employer Participation Agreements

• 2019 CareWorks Comp Group Rating Participation Agreement
• 2019 CareWorks Comp Group Retrospective Rating Plan Participation Agreement
• 2021 CareWorks Comp Group Rating Participation Agreement
• 2021 CareWorks Comp Group Retrospective Rating Participation Agreement

Public Employer Participation Agreements

• 2021 CareWorks Comp Public Group Participation Agreement
• 2021 CareWorks Comp Public Group Retro Participation Agreement

NFIB Group Rating and Group Retrospective Rating Participation Agreements

• 2020 NFIB Group Amendment
• 2020 NFIB Group Participation Agreement (starting 3/1)
• 2020 NFIB Group Participation Agreement (starting 1/1)
• 2020 NFIB Group Retro Participation Agreement (starting 3/1)
• 2020 NFIB Group Retro Participation Agreement (starting 1/1)
• 2021 NFIB Group Retro Participation Agreement (starting 3/1)
• 2021 NFIB Group Retro Participation Agreement (starting 1/1)
• 2021 NFIB Group Participation Agreement (starting 3/1)
• 2021 NFIB Group Participation Agreement (starting 1/1)
• 2021 NFIB Group Amendment

NFIB Select Program Plus Participation Agreements

• 2020 NFIB Select Program Plus Amendment
• 2020 NFIB Select Program Plus Participation Agreement (starting 1/1)
• 2020 NFIB Select Program Plus Participation Agreement (starting 3/1)
• 2021 NFIB Select Program Plus Participation Agreement (starting 3/1)
• 2021 NFIB Select Program Plus Participation Agreement (starting 1/1)
• 2021 NFIB Select Program Plus Amendment

Safety Resources

• Ohio Safety Resources