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

BWC-1286 -- WAIVER OF WORKERS’ COMPENSATION BENEFITS FOR RECREATIONAL OR FITNESS ACTIVITIES (C-159). This form is used by the Bureau of Workers' Compensation and allows employees to waive workers’ compensation coverage for voluntary participation in employer-sponsored recreational activities or fitness programs. The form requires the employee's name, date, employer name, policy number, and a list of the activities/programs for which coverage is waived. 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