Work Status Form (formerly Worker Verification Form)

Document Information
  How to complete a fillable form.
Title Work Status Form (formerly Worker Verification Form)

This form was previously called the Worker Verification Form. This is to be completed by the injured worker if they are unable to work due to a workplace injury AND their employer is not paying their full wages.


Document number F242-052-000
How to get this document
Alt Language(s) Español
Valid dates 11/2014
Contact information Managing Injured Workers' Claims
Websites Workers' Comp Claims

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