SIF-5A Cover Sheet: Wage Calculations

SIF-5A Cover Sheet: Wage Calculations - (Forms/Publications)
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Title SIF-5A Cover Sheet: Wage Calculations (84 KB XLS)

Used by only self-insured employers and their representatives to calculate and report injured workers’ wages and time loss compensation rates.

Form number F207-156-000
Online only. See document above to download.
Keywords calculations, injuries, injury, self insurance, self insurer, self-insurance, self-insurer, SIF5, SIF5-A, SIF5A, time-loss, time-loss compensation, wage, wages, worker's compensation, workers compensation, workers' compensation
Languages English
Valid dates 10-2013
Contact information Self-Insurance
Related information

Self-Insurance Report of Occupational Injury or Disease (SIF-5)

Web pages Insurance for Business
Self-Insured Employers
Checklists & Instructions for self-insurers

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