Waiver Of Workers Compensation Benefits For Recreational Or Fitness Activities {BWC-1286}

BWC-1286 / C-159 -- WAIVER OF WORKERS’ COMPENSATION BENEFITS FOR RECREATIONAL OR FITNESS ACTIVITIES. This form waives workers’ compensation coverage for an employee’s voluntary participation in an employer-sponsored recreation or fitness activity. The employee must sign and date this waiver prior to engaging in the employer-sponsored recreation or fitness activity listed below for this waiver to be valid. The employer must retain the original for their records, provide a copy to the employee, and submit a copy to BWC only if the employee files a workers’ compensation claim for an injury or occupational disease sustained during the employer-sponsored recreation or fitness activity listed on the form. By signing the form, the employee acknowledges their waiver of workers’ compensation benefits for injuries sustained during participation in the listed activities/programs. The waiver is valid for two years and does not apply to death benefits claims by dependents. www.FormsWorkflow.com