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Forms listed here are in Portable Document Format (PDF).
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AultComp MCO Selection Form
BWC Report Card Ratings
Online Injury Form
Printable Injury Form
First Report of an Injury, Occupational Disease or Death
Physician's Report of Work Ability
Instructions for completing Physician's Report of Work Ability
Forms for Recording Work-Related Injuries and Illnesses Booklet
Accident/Incident Report
Witness Report
First Aid Report Form
Forms listed here are in Portable Document Format (PDF).
You will need Acrobat Reader plug-in to open PDF files. Please visit the Adobe website to download the plug-in.
Some forms may be available for electronic filing.
AultComp MCO Selection Form
BWC Report Card Ratings
Online Injury Form
Printable Injury Form
First Report of an Injury, Occupational Disease or Death
Physician's Report of Work Ability
Instructions for completing Physician's Report of Work Ability
Forms for Recording Work-Related Injuries and Illnesses Booklet
Accident/Incident Report
Witness Report
First Aid Report Form
AultComp MCO, Inc.
PO Box 36149 Canton, Ohio 44735-6149 AultComp MCO, Inc. 4650 HIlls & Dales Rd NW Suite 360 Canton, Ohio 44708 |
Service Center Hours:
8:00 am to 5:00 pm EST Phone: 330-830-4919 Toll Free: 1-888-738-5800 Medical Repository Fax: 330-830-4900 1-877-738-0058 |
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