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OH BWC-6102 2013 free printable template

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Injured Worker Authorized Representative Instructions The injured worker and representative must complete this form in its entirety and file it with BWC. A valid BWC Representative ID number is required.
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How to fill out OH BWC-6102

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How to fill out OH BWC-6102

01
Obtain the OH BWC-6102 form from the Ohio Bureau of Workers' Compensation website or your employer.
02
Fill in the employee's name, address, and date of birth in the designated fields.
03
Provide the employee's Social Security number.
04
Enter the employer's name, address, and BWC policy number.
05
Complete the section regarding the date of the injury and how it occurred.
06
Describe the nature of the injury in detail.
07
Include any treatment the employee has received or plans to receive.
08
Sign and date the form at the bottom.
09
Submit the completed OH BWC-6102 to the appropriate BWC office or your employer.

Who needs OH BWC-6102?

01
Employees who have sustained a work-related injury or illness.
02
Employers who need to report a work-related injury or illness to the Ohio Bureau of Workers' Compensation.
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OH BWC-6102 is a form used in Ohio for reporting workplace injuries and illnesses for workers' compensation purposes.
Employers with employees who sustain a compensable work-related injury or illness are required to file OH BWC-6102.
To fill out OH BWC-6102, provide accurate information regarding the injured worker, details of the incident, and any medical treatment received. Ensure all fields are completed according to the instructions provided by the Ohio Bureau of Workers' Compensation.
The purpose of OH BWC-6102 is to report injuries and illnesses that occur in the workplace to facilitate workers' compensation claims and to track workplace safety.
The information that must be reported on OH BWC-6102 includes the worker's personal information, details of the injury or illness, date and location of the incident, a description of what happened, and any medical treatment received.
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Related Links

Forms - Industrial Commission - Ohio.gov
Employer Photo ID Form ... R-2 Injured Worker Authorized Representative. All other BWC forms can be found by visiting their website at bwc.ohio.gov.

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