Ohio's First Report of an Injury, Occupational Disease or Death starts a workers' compensation claim, and treating providers are often the ones who report it. The injured worker, employer and treating provider each complete a block; the provider's section lists the diagnoses with ICD codes and states whether they are causally related to the reported accident or exposure. Filing online returns a claim number immediately.
Whoever files fills in the worker, job and accident details, often the provider's office, and the injured worker signs the worker statement; the treating provider completes the 'To be completed by the treating provider' block with diagnoses, initial treatment date, causality, physician-of-record status and BWC provider number. The employer certifies, rejects or clarifies the claim in its own block.
Enter the worker's name, date of injury or disease, Social Security number, date of birth, mailing address, sex, email and phone numbers. BWC's reporting page lists these among the details a provider must gather when reporting a new injury, so collecting them at the first visit avoids delays even if the worker signs later.
Record the employer's name and address, whether the worker was hired through a temp agency, usual workdays and regular hours, date hired, job title, the states where the worker was hired and supervised, wage rate, hours scheduled the week of the injury and the call-off number. BWC's reporting page lists employer name, address and telephone as required information.
Describe the sequence of events that directly caused the injury or death and the body parts affected, for example left knee. Add start time and time of injury, when the employer was notified, date last worked, whether a workday was missed and whether it happened on the employer's premises. Then give the initial treatment date, facility, treating provider, whether 8 or more days will be missed, any return-to-work date and overnight hospitalization.
Complete this only for fatal claims: enter the date of death, the decedent's marital status (single, married, divorced, separated or widowed) and the decedent's number of dependents. Deaths are reported on the same FROI as injuries and occupational diseases, so the rest of the form is still completed.
The worker signs statements electing Ohio workers' compensation and waiving benefits under other states' laws for this injury. The worker also acknowledges that treating providers may, on request, submit medical, psychological, psychiatric or vocational documentation relevant to the claim to BWC, the employer, the MCO or their representatives, and certifies the form is true under a felony fraud warning.
List each diagnosis as a narrative with location, body part and ICD code, naming the condition rather than the symptom or exposure. Enter the initial treatment date, answer yes or no on whether the conditions are causally related to the reported work-related accident or occupational disease, and say whether you are the physician of record. Print your name and BWC provider number, add phone, fax and email, then sign and date.
The employer gives its name, county, policy number and federal ID, notes whether the worker is an owner, partner or individual incorporated as a corporation, and either certifies the facts, rejects the claim with reasons, or clarifies and allows it for listed conditions. Self-insuring employers also mark the claim as medical only or lost time.
Download the current version from the source each time; forms change without notice.
First Report of an Injury, Occupational Disease or Death
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Within one business day of the initial treatment or visit. Ohio Administrative Code 4123-6-02.8 requires BWC-certified providers to report the injury to the responsible MCO, either by calling the MCO or by filing the FROI online. When the injured worker's employer is self-insuring, the report goes directly to the employer instead.
The treating physician or provider prints their name, adds the BWC provider number, signs and dates the block, and indicates whether they are the physician of record. When the BWC provider number reaches the MCO, BWC sends the reporting provider or the provider of record a letter with the claim status and allowed conditions.
A narrative description of each condition with location, body part and ICD code, naming the injury itself rather than symptoms or the exposure. BWC's reporting policy says diagnosed conditions should be determined by a qualified practitioner, be causally related to the occupational injury or illness, and be updated as the medical conditions in the claim change.
Yes. BWC accepts the FROI online through bwc.ohio.gov, and filing it electronically gives the provider a claim number right away. The printed form can also be faxed or mailed to BWC. Claims against self-insuring employers go to the employer's workers' compensation manager rather than to BWC.