OH BWC SH-12 2020-2025 free printable template
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Division of Safety and HygienePublic Employment Risk Reduction Program 30 W. Spring St., 25th Floor Columbus, OH 432152256 6146442246 or 8006716858 Fax: 6146215754Sharps Injury Form Needle stick ReportInstructions:
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How to fill out OH BWC SH-12
How to fill out OH BWC SH-12
01
Obtain the OH BWC SH-12 form from the Bureau of Workers' Compensation website or your employer.
02
Fill in your personal information, including your name, address, and contact details.
03
Enter your Social Security number and the name of your employer.
04
Provide the date of the injury and a detailed description of the incident.
05
Include information on medical treatment received, such as the name of the healthcare provider and dates of visits.
06
Sign and date the form to certify its accuracy.
07
Submit the completed form to your employer or directly to the BWC as instructed.
Who needs OH BWC SH-12?
01
Anyone who has suffered a workplace injury in Ohio and needs to file a claim for workers' compensation benefits.
02
Employers who are required to report workplace injuries to the Ohio Bureau of Workers' Compensation.
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What is OH BWC SH-12?
OH BWC SH-12 is a form used by Ohio employers to report their workers' compensation insurance coverage to the Ohio Bureau of Workers' Compensation (BWC).
Who is required to file OH BWC SH-12?
All Ohio employers who have employees and are enrolled in the Ohio Workers' Compensation system are required to file OH BWC SH-12.
How to fill out OH BWC SH-12?
To fill out OH BWC SH-12, employers should include their business information, such as name, address, and BWC policy number, along with details of their employees and coverage period as required by the form.
What is the purpose of OH BWC SH-12?
The purpose of OH BWC SH-12 is to ensure that employers are compliant with workers' compensation insurance requirements and to facilitate the monitoring of insurance coverage by the BWC.
What information must be reported on OH BWC SH-12?
The information that must be reported on OH BWC SH-12 includes the employer's name and address, BWC policy number, the type of business, number of employees, and any relevant coverage dates.
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