Holmes Area Safety Council Enrollment

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, the BWC's Division of Safety & Hygiene and your local safety council co-sponsor this program.

Company Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone

Average Number of Employees

Type of Work

BWC Policy Number

Enrollment Year

Your Name

Title

I Agree

By clicking "I Agree" below and submitting this 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.

I Agree

Please verify that you have checked the “I'm not a robot” checkbox.