Get Vermont Dol Form 25

Filling out the Vermont Dol Form 25 online is a straightforward process that ensures accurate reporting of an employee's wage details following a workplace injury. This guide will provide you with step-by-step instructions to assist you in completing the form effectively.

Follow the steps to complete the Vermont Dol Form 25.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the state file number and the insurance company file number associated with the claim at the top of the form. These numbers help identify the case uniquely.
3. Input the date of injury in the designated field. Ensure that this date is accurate as it is crucial for processing the claim.
4. Next, fill in the federal ID number for identification purposes. This number is typically assigned to employers and used for tax purposes.
5. Upon reaching the wage statement section, begin by entering the employee's name and the employer's name in the appropriate fields.
6. Specify the wage rate of the employee, detailing the amount per specified time period (hourly, weekly, etc.). This information is vital for calculating fair compensation.
7. Record the number of hours or days worked in the provided fields. This should accurately reflect the work pattern prior to the injury.
8. In the gross wages section, include the total income earned by the employee for the previous 26 weeks before the accident, excluding the week of the accident itself.
9. If applicable, list any extras in the designated section, providing a clear description of what these extras are, such as bonuses or tips that are not included in gross wages.
10. Indicate whether the employee began losing time due to the injury by selecting 'Yes' or 'No,' and if 'Yes,' provide the relevant details.
11. Fill out the information regarding payment for the day of the accident and whether the employee’s wages are subject to any child support withholding orders.
12. Provide the date the form is being filled out and include the position title of the person completing the form.
13. Finally, ensure to review all the details for accuracy before proceeding to submit the form online. Once completed, you can save changes, download, print, or share the form as necessary.

Complete your Vermont Dol Form 25 online today to ensure proper processing of your claim.