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WAGE STATEMENT RECEIVED BY CLAIMS-HANDLING ENITY FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION NOTICE TO EMPLOYEE: If you have any questions about the information contained.

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How to fill out the Dwc 1a online

Filling out the Dwc 1a form online is an essential task for accurately reporting employee wage statements in the event of a workplace injury. This guide provides step-by-step instructions to ensure users can complete the form effectively.

Follow the steps to successfully complete the Dwc 1a form.

  1. Press the ‘Get Form’ button to access the Dwc 1a form and open it for editing.
  2. Begin by entering the employee's name in the designated field, including their first, middle, and last names. This is crucial for accurate identification.
  3. Input the date of the accident using the format Month-Day-Year to provide a clear context for the event.
  4. Fill in the employer's name and address in the specified sections to establish the employment relationship.
  5. If applicable, provide the name and address of any concurrent employer, which might be pertinent for additional compensation contexts.
  6. Indicate whether the wages listed are for a similar employee by checking either ‘Yes’ or ‘No.’ This helps clarify wage standards.
  7. In the section for the similar employee, enter their name, telephone number, and occupation to validate the wage comparison.
  8. Record the employee's customary work week in the provided format, such as Saturday through Friday, specifying the total calendar days.
  9. Complete the field for the employee's customary days worked per week, providing a clear figure such as ‘5 days/week’.
  10. Detail the employee's customary hours worked per week to reflect their regular schedule, like ‘40 hours/week.’
  11. Enter the employer's customary work week in the same format to offer a basis of reference for employment norms.
  12. Proceed to list the wages earned for each of the 13 calendar weeks leading up to the accident. Ensure to follow the structure provided, avoiding any wages earned during the week of the accident.
  13. Do not combine wages of two or more employees; report the individual wages clearly for accurate processing.
  14. Complete the sections for total fringe benefits and total gross pay, ensuring all figures are accurately calculated.
  15. Conclude by providing your contact information and the date for the preparer’s section, making sure all entries are correct before submission.
  16. Finally, save your changes, and if necessary, download, print, or share the completed form with the relevant claims-handling entity.

Complete your Dwc 1a form online today to ensure accurate wage reporting.

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DWC1 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.

The CA-1 form is used if the employee has sustained a Traumatic Injury on the job. Traumatic Injury - A wound or other condition of the body caused by external force, including stress or strain.

Division of Workers' Compensation (DWC)

The Commission on Health and Safety and Workers' Compensation is a joint labor-management body created by the workers' compensation reform legislation of 1993 and charged with overseeing the health and safety and workers' compensation systems in California and recommending administrative or legislative modifications to ...

California Workers' Compensation Insurance Forms CA 130 Workers' Compensation Application. ... California Employer Fact Sheet for Employers. ... California Application for Exclusion of Officers and Stockholders. ... CA Affidavit of Exemption for Workers' Compensation Insurance. ... CA First Report of Injury Form.

Your employer should fill out the “employer” section and forward the completed claim form to the insurance company. You should receive a copy of the completed claim form from your employer. If you don't, request a copy and keep it for your records.

DWC-1 Workers Compensation Claim Form. This is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within one working day from you becoming aware of a work-related injury or occupational disease.

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