Southern Buckeye Safety Council
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ENROLL ONLINE
SEMI-ANNUAL REPORT
Sponsorships
EVENTS CALENDAR
Contact
Home
ENROLL ONLINE
SEMI-ANNUAL REPORT
Sponsorships
EVENTS CALENDAR
Contact
Online Enrollment Form
Southern Buckeye Safety Council
In an effort to reduce the number of workplace accidents and to share resources and information on accident prevention, risk management and workers’ compensation in Ohio, BWC’s Division of Safety & Hygiene and the Southern Buckeye Safety Council co-sponsor this service.
In signing this enrollment form, the employer makes a commitment to send representatives to the majority of safety council meetings and to submit semi-annual reports by the deadline dates.
If you have questions or need help while completing this form please contact
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Indicates required field
Enrollment Date:
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Employer Name:
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Address (Line 1)
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Address (Line 2)
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City
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State
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Zip Code
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County
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Phone Number
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Email
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Average number of employees:
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Type of work (i.e.: Contruction, Food Service, School, Social Services, etc.)
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BWC Policy Number (Enter "0" if unknown)
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Name
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First
Last
Title:
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How did you hear about us?
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If you were referred, who referred you?
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Signature (Retype your name)
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Signature Date:
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Semi-Annual Report
DOWNLOAD SEMI-ANNUAL REPORT FORM
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