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OhioBWC - Employer - Form: (U-140) - Application for Drug-Free Workplace Program and Drug-Free EZ
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Application for Drug-Free Safety Program (U-140)
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Introduction
The Drug-Free Safety Program (DFSP) is a rate program that offers a
premium discount to eligible employers for implementing a loss-prevention
strategy to address workplace use and misuse of alcohol and other drugs,
including prescription, over-the-counter and illegal drug abuse within
the context of a holistic safety program.
Notice: We will begin to phase out the Drug-Free Workplace and
Drug-Free EZ programs effective July 1, 2010. We've designed the DFSP to be
more effective by incorporating drug-free principles and processes into
your company's complete safety program.
DFSP vs. DFWP and Drug-Free EZ
- Wider reaching with expanded benefits
- Benefits not limited to five years
- Simpler and easier to implement than DFWP or DF-EZ:
one program with two levels, basic and advanced
- Streamlined application process
- Effective with measureable results
- Streamlined safety components
- Better reporting data
- Continuous measurement and evaluation
- Actuarially sound
To find out who's eligible to participate and the program requirements,
click on the DFSP info link below under Additional information. To apply
for the DFSP, click on the Print a blank form link at the bottom of this page
and fax it to BWC.
You'll see additional information also is available for state construction
contractors or subcontractors wanting to understand their requirements
prior to providing labor services or onsite supervision of labor
services on a State of Ohio public improvement/construction project. If you're
searching for a vendor to assist with your drug-free services, you'll
find the DFSP Vendor Directory.
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Additional information
DFSP info
State construction contractor information
Drug-Free Vendor Directory
Program Discount Compatibility
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Required information
- Name of employer
- Doing business as (DBA) name
- Address
- Telephone number
- Federal tax ID number
- Employer contact person
- Employer contact telephone number
- Average number of employees
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- Employer has Internet access and is willing to receive
correspondence via e-mail
- E-mail address to which BWC can send correspondence
to drug-free contact person
- Requested DFSP policy year
- Advanced, basic or comparable program
- Name of designated employer representative and e-signature
if submitted online
- Name of designated employer representative and signature
if not submitted online
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| Complete the forms |
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The free Adobe Reader
software is required to display and print the application.
Do you have all the required information at hand? If so, you are ready to begin
completing the form. When completing the online form, please use the previous
and next buttons located at the bottom of the page to navigate
through the form.
Begin online form now.
To print a blank copy of the form to complete by hand and either mail or fax it
to BWC, click the link below.
Print a blank form.
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