Get Request For Income Loss, Form 25w100 - Worksafebc.com

Filling out the Request For Income Loss, Form 25W100 online is an essential step for individuals looking to report their income loss related to a WorkSafeBC appointment. This guide provides clear instructions for each section of the form to ensure accuracy and completeness.

Follow the steps to successfully complete your form.

1. Press the ‘Get Form’ button to access the Request For Income Loss, Form 25W100.
2. Enter the worker's last name, first name, and middle initial in the designated fields.
3. Input the appointment date in the specified format (yyyy-mm-dd).
4. Indicate the location and purpose of the appointment clearly.
5. Provide the WorkSafeBC claim number to link the form with the applicable claim.
6. Specify the appointment time by selecting either a.m. or p.m. and entering the relevant time.
7. In the income loss information section, answer the questions regarding the appointment to facilitate reimbursement for lost wages.
8. For employer details, fill in the current employer's name and their address accurately.
9. Confirm the date(s) and hours lost due to the WorkSafeBC appointment, and indicate whether the hours lost were rescheduled.
10. If applicable, enter the hourly rate of pay or equivalent hourly rate if salaried.
11. Calculate and enter the total wages lost for this appointment.
12. If the worker is engaged in commission, piecework, or contract work, provide an estimate of the gross amount for hours lost.
13. Self-employed individuals should indicate whether they have Personal Optional Protection.
14. Identify the normal working week by entering hours worked each day from Sunday to Saturday.
15. Confirm if the worker will be paid by the employer for the time lost due to the appointment.
16. If payment will be made, specify who the cheque should be payable to.
17. Obtain signatures from both the employer and the worker, and print their names, occupations, and titles as required.
18. Finally, enter the employer's phone number along with the date in the format (yyyy-mm-dd).
19. Once all fields are completed, save changes and download the form, or print and share it as necessary.

Complete the Request For Income Loss, Form 25W100 online to facilitate your claim process efficiently.