Report Of Employees Wages | Pdf Fpdf Docx | Connecticut

 Connecticut   Workers Compensation 
Report Of Employees Wages | Pdf Fpdf Docx | Connecticut

Last updated: 10/7/2025

Report Of Employees Wages

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Description

REPORT OF EMPLOYEE'S WAGES. This form is used in workers’ compensation claims to record an employee’s earnings during the 52-week period prior to the date of injury. Employers must complete this form to provide accurate payroll data for determining the employee’s average weekly wage and calculating benefits. The form includes fields for employment duration, pay rate, payment method (hourly, weekly, or monthly), and whether wages were shared with helpers. Employers record weekly gross wages for up to 52 weeks and certify that the information is correct based on official payroll records. www.FormsWorkflow.com

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