SCSC Enrollment Form - Canton Regional Chamber of Commerce

SCSC Enrollment Form

BWC’s Division of Safety & Hygiene co-sponsors safety councils to provide Ohio employers with access to occupational safety and health, workers’ compensation and risk management education, networking, and resource sharing.

In completing this enrollment form, the employer makes a commitment to send representatives to monthly safety council meetings.

Fields marked with an * are required.

Employer Name *

Physical Address *

City *

State *

Postal Code

Phone *

Email *

BWC Policy Number *

Type Full Name for Signature *

Title *

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