• Home
  • About Us
  • AultValue
  • Employers
  • Injured Workers
  • Providers
  • Newsroom
  • Forms
  • Claims Management
  • Customer Service
  • Contact Us
AultCompMCO
  • Home
  • About Us
  • AultValue
  • Employers
  • Injured Workers
  • Providers
  • Newsroom
  • Forms
  • Claims Management
  • Customer Service
  • Contact Us
AultCompMCO

Forms

Translate this page in your preferred language:

You can translate the contents of this page by selecting a language in the select box.


Complete the online enrollment form
Prior to downloading your form, please note the following:
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

Utility
Privacy Policies
​
AultCare Wellness
Forms
Contact Us
View Site Directory
Picture
© COPYRIGHT 2023 AultCompMCO
​ALL RIGHTS RESERVED.
Picture
Picture
Picture
Picture
Picture