Ohio bwc c 55 form 2026

1. Click ‘Get Form’ to open the Ohio BWC C-55 form in our editor.
2. Begin by entering the employee's name and employer's name in the designated fields at the top of the form.
3. Fill in the claim number and policy number accurately to ensure proper processing.
4. Provide the employer's telephone number for any necessary follow-up communication.
5. In the section regarding salary continuation, specify the amount being paid per week or bi-weekly, along with the start and end dates of this payment period.
6. Indicate whether the salary/wages include payments from other employment by selecting 'Yes' or 'No'.
7. Ensure both the employee and employer sign and date the form at the bottom before submission.
8. Once completed, fax or mail your agreement to your local BWC service office for processing.

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