Worker verification 2026

1. Click ‘Get Form’ to open the worker verification form in the editor.
2. Begin by entering your claim number, date of request, and date of injury at the top of the form. These details are crucial for processing your request.
3. Fill in your personal information including your name, phone number, and address. If you have a new address or phone number, ensure to update this section.
4. In the Worker’s Statement section, indicate the period during which you were unable to work due to your injury. Be specific about the dates and avoid including the last date worked.
5. Provide details about your current working hours and days per week. If applicable, mention when you returned to work.
6. List any benefits you have applied for and state your current wage per hour, day, week, or month as appropriate.
7. Answer questions regarding employer-provided benefits on the date of injury and indicate if you are still receiving these benefits.
8. Finally, sign and date the form at the bottom. Ensure that all information is accurate before submitting it.

Start filling out your worker verification form online for free today!