Agreement For Temporary Compensation {32}

FORM 32 - AGREEMENT FOR TEMPORARY COMPENSATION. This form issued by the Vermont Department of Labor is used to document and formalize the payment of temporary disability benefits to an employee who has been injured on the job. This form outlines the details of the injury, identifies the injured body part(s), and specifies the number of dependents and the employee's average weekly wage prior to the injury. It indicates whether the compensation is for an initial or additional period of disability and provides the payment rate—such as a percentage of the average weekly wage or a minimum/maximum statutory rate. The form includes signatures from both the insurance adjuster and the employee, indicating mutual agreement to the compensation terms. In addition, it provides important information about the employee’s potential eligibility for Unemployment Insurance benefits once temporary total disability ends. By signing, the employee confirms they are not currently working and agrees to promptly report any subsequent earnings or employment. The agreement must be approved by the Commissioner of Labor or their designee to be valid. www.FormsWorkflow.com