Get Average Weekly Wage Worksheet - Colorado.gov

Filling out the Average Weekly Wage Worksheet is essential for accurately determining an employee's compensation following a workplace injury. This comprehensive guide will walk you through each section of the worksheet, ensuring a clear understanding of the process and helping you submit the form correctly.

Follow the steps to complete the Average Weekly Wage Worksheet effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the worker's compensation claim number (WC#) at the top of the form. This number is critical for tracking the claim in the system.
3. Complete the employee's name and Social Security number (SS#) along with the carrier number. These details help identify the concerned parties in the claim process.
4. Indicate the time period for calculations by entering the start date (From ___/___/___) and the end date (TO ___/___/___) to specify the relevant earnings period.
5. Choose one from lines 1 through 7 that best reflects the employee's earnings. Input the corresponding amounts and calculations in each line according to the method of payment: hourly, daily, weekly, bi-weekly, semi-monthly, monthly, or yearly.
6. If applicable, provide additional information on piecework or commission under line 8, including the total earnings amount and the number of weeks worked.
7. For mileage, if it applies, calculate the average rate per mile driven for work purposes. Use line 9 to enter the amounts based on the previous 60 days.
8. If there are other wages not addressed previously, enter them on line 10 and provide an explanation if necessary.
9. Under additions to wages, fill out lines 12 and 13 for any overtime and tips, respectively, along with their corresponding calculations.
10. Complete the benefits section if any benefits were discontinued due to disability. Provide details on health insurance, meals, and rent/housing under lines 15 to 18.
11. The total average weekly wage is calculated by summing the totals from lines 11, 14, and 18. This final figure should be entered in line 19.
12. After all calculations are complete, ensure the form is signed and dated by the necessary individual before submission.
13. Save the completed form, and consider downloading or printing a copy for your records. You may also share it with relevant parties as needed.

Complete your Average Weekly Wage Worksheet online to ensure accurate and timely compensation for workplace injuries.