• About Us
  • Safety
  • Workers Compensation
  • Property/Casualty
  • Events
  • Training Presentations
  • Forms
  • Links


    The following forms are available for download in PDF format.

     For Montgomery County employees only!



    PDF Document Icon Vehicle Accident Report

    Vehicle Accident Report

    PDF Document Icon Citizen Injury/Loss or County Property Loss Report

    Citizen Injury/Loss or County Property Loss Report

     PDF Document Icon Supervisor's Investigation Report

    Supervisor's Investigation Report, Citizen Injury/Loss or County Property (including Vehicle Accidents)

     PDF Document Icon Witness Statement

    Witness Statement
    PDF Document Icon Employee Injury Report EIR - Employee Injury Report
    PDF Document Icon Supervisor's Investigation Report

    SIR - Supervisor's Investigation Report - Work Related Employee Injury, Illness, Near Miss Incidents

    PDF Document Icon Witness Statement

    Witness Statement

    PDF Document Icon BWC C84

    Ohio BWC Request for Temporary Total Compensation 

    PDF Document Icon BWC C-101

    Authorization Release of Medical Information

    PDF Document Icon BWC C-159

    Waiver for Recreational Activity

    PDF Document Icon  SH-12 SHARPS INJURY FORM

    Sharps Injury Form

    PDF Document Icon  FROI

    First Report of Injury

     PDF Document Icon WCRA

    Wage Continuation Reimbursement Agreement








    2014 Safety Breakfast with the Experts

    2014 BWC Ohio Safety Congress