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    The following forms are available for download in PDF format.

     For Montgomery County employees only!



    PDF Document Icon Accident Report

    Vehicle/Property/Citizen Loss

    PDF Document Icon Supervisor's Investigation Report

    For Property & Citizen's Losses
    PDF Document Icon Witness Statement For both Property & Employee Accidents
    PDF Document Icon Employee Injury Report Employee Injury/Illness or Near Miss Incidents
    PDF Document Icon Supervisor's Investigation Report

    For Work-Related Employee Injury/Illness & Near Miss Incidents

    PDF Document IconWitness 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


    Wage Continuation Reimbursement Agreement








    2014 Safety Breakfast with the Experts

    2014 BWC Ohio Safety Congress