The forms listed below are those used most often in processing workers' compensation claims. To use these forms you can:

• Click below, complete online and print OR print and complete in ink
• Contact the Hamilton County Workers' Compensation Specialist
• Contact your Departmental Workers' Comp Liaison
• Bureau forms are available by contacting your Bureau representative or Managed Care Organization (MCO) claims specialist.

The Employee Action Step Timeline/Checklist is a resource to help employees follow the appropriate steps for workers' compensation claims.

Initial Action Steps - employee procedure upon notice of a work related incident.

Medical Treatment - employee procedure for seeking medical attention after a work related incident.

Return to Work - options available to provide injured workers with a safe return to work after a work related incident.

Vocational Services - individualized and voluntary programs for eligible injured workers needing assistance in safely returning to work or in retaining employment after a work related incident.

Compensation - employee eligibility for compensation for lost wages due to a work related incident.

Motor Vehicle Accident - employee procedure when involved in a motor vehicle accident.

Form Summary - forms identified in the employee section.

The Supervisor Action Step Timeline/Checklist is a resource to help supervisors follow the appropriate steps for workers' compensation claims.

Initial Action Steps - supervisor/department head procedure upon notice of a work related incident.

Medical Treatment - supervisor/department head procedure if an employee seeks medical attention because of a work related incident.

Fatality or Multiple Injury Incident - OAC mandate in the event of a fatality or multiple injury incident due to a work related incident.

Vocational Services - individualized and voluntary programs for eligible injured workers needing assistance in safely returning to work or in retaining employment after a work related incident.

Compensation - supervisor/department head procedure to assist employees with eligibility for compensation for lost wages due to a work related incident.

Form Summary - forms identified in the supervisor/department head section.

Initial Action Steps– dept/agency workers’ comp liaison procedure upon notice of a work related incident.

Medical Treatment- dept/agency workers’ comp liaison procedure if an employee seeks medical attention because of a work related incident.

Return to Work - dept/agency workers’ comp liaison procedure when an employee returns to work after a work related incident.

Compensation - dept/agency workers’ comp liaison procedure to assist employees with eligibility for lost wages due to a work related incident.

Form Summary – forms identified in the dept/agency workers’ comp liaison section.

Initial Action Steps - how the managed care organization proceeds upon notice of a work related incident.

Medical Treatment - how the managed care organization assists an employee with medical treatment after a work related incident.

Return to Work - how the managed care organization assists in returning an employee to work after a work related incident.

Initial Action Steps - how the Ohio Bureau of Workers' Compensation proceeds upon notification of a work related incident.

Compensation - how the Ohio Bureau of Workers' Compensation orders compensation.

Initial Action Steps - how the physician of record proceeds upon treatment of the initial injury of a work related incident.

Medical Treatment - the physician of record's obligation to submit reports related to treatment for a work related incident.

Return to Work - how the physician of record guides the return to work of an employee after a work related incident.

Recording and Records Retention - the physician of record's obligation to retain records for a work related incident.

Compensation - how the physician of record assists the injured worker obtain compensation for lost wages due to a work related incident.

Initial Action Steps - how the third party administrator proceeds upon notice of a work related incident.

Compensation- how the third party administrator proceeds upon notice that an injured worker is seeking compensation for a work related incident.

Adjudication - how the third party administrator proceeds in matters needing adjudication before the Bureau and the Industrial Commission.

Initial Action Steps - what the Industrial Commission of Ohio does.

Adjudication - the administrative appeals process of the Industrial Commission of Ohio.

Adjudication - the administrative appeals process of the Ohio Attorney General's Office.

Listed below are links to websites with useful information regarding workers' compensation.

• Sheakley (MCO)   

• Employee Assistance Program (EAP)

• Family Medical Leave Act (FMLA)  

• Industrial Commission of Ohio (IC)   

• National Institute of Occupational Safety & Health (NIOSH)   

• Ohio Bureau Of Workers’ Compensation (OBWC)   

• Ohio Public Employees Retirement System (OPERS)   

• Ohio Revised Code (ORC) 4123.01  

• Public Employers Risk Reduction Program (PERRP)