Get Weekly Earnings Schedule 52 Weeks Form

The Weekly Earnings Schedule 52 Weeks Form is crucial for reporting earnings related to a workplace injury. This guide will provide you with step-by-step instructions to efficiently complete the form online.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the Weekly Earnings Schedule 52 Weeks Form and open it in your preferred online editor.
2. Begin by entering the employer location code and the date at the top of the form. Ensure that these fields are filled out accurately to reflect your work details.
3. Fill in the employer's name and the date of the accident. This information is essential for linking the earnings with the specific injury case.
4. Input the employee's name, along with the date the disability began and the date compensation starts. These dates help track the timeline of earnings related to the disability.
5. Record the date employed and the employee’s social security number. This information is needed for identification and record-keeping purposes.
6. In the first section titled 'Indicate only those wages earned by injured employee during 52 week period immediately preceding accident,' input the earnings for each week, specifying the amount paid excluding overtime and any payments made for overtime or extra work.
7. Repeat this process for all 52 weeks, ensuring the dates and amounts are reflected accurately for each respective week.
8. After completing all weeks, carry forward totals as indicated on the form. Double-check for accuracy in the calculations.
9. In the remark section, provide any additional information necessary that may assist in clarifying the earnings situation.
10. Finally, certify the form by signing and including your title. Review all sections before saving your changes, and proceed to download, print, or share the completed form as needed.

Complete the Weekly Earnings Schedule 52 Weeks Form online today to ensure compliance and timely processing.