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In an effort to reduce the number of workplace accidents and to share resources and information on accident prevention, risk management, worker’s compensation and other safety issues in Ohio BWC’s Division of Safety & Hygiene and the Canton Regional Chamber of Commerce co-sponsor the Stark County Safety Council

In completing this online 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.

Question Title

* Please enter your company information.

Company Name:

Primary Contact:

Primary Contact Title:

Primary Contact Email:

Secondary Contact:

Secondary Contact Title:

CEO:

CEO Title:

Safety Director:

Safety Director Email:

Company Street Address:

City:

State:

Zip:

Company Phone Number:

Average Number of Employees:

Company Fax Number:

Company/Organization's Website Address:

Type of Work:

BWC Policy Number:

Your Name:

Question Title

* Comments/Questions:

BWC ACCOUNT NUMBER WILL BE ASSIGNED AFTER YOUR APPLICATION HAS BEEN APPROVED.

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