Get Oh Bwc-1178 2014-2025

The OH BWC-1178 form, known as the Injured Worker Statement for Reimbursement of Travel Expense, is essential for individuals seeking travel expense reimbursement due to work-related injuries. This guide provides clear and detailed instructions to assist users in completing the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Fill in the injured worker information. Provide your last name, first name, middle initial, social security number, street address or P.O. box, city, state, telephone number, and nine-digit ZIP code.
3. Enter your claim number in the designated field.
4. List the travel date in chronological order by entering the month, day, and year of travel in the appropriate section.
5. Indicate the cities you traveled from and to. Ensure to use only one 'from' and 'to' box for each round trip.
6. For total car mileage per trip, enter the total number of miles traveled to your destination each day.
7. Describe other types of travel, specifying the type of transportation used and entering the costs associated with that transportation.
8. Outline other expenses, categorizing them into miscellaneous (like parking and tolls, which require receipts), meals, and lodging. Remember that lodging expenses must be pre-authorized.
9. Select the reason for travel by checking the appropriate option provided on the form.
10. In the signature and date section, sign your full name and enter the date you completed the form.
11. Upon completing the form, review all entered information for accuracy, then save any changes, download, print, or share the form as necessary.

Complete your OH BWC-1178 form online today to ensure a smooth reimbursement process.