Temporary workers 2026

This document is a Notice of Temporary Compensation Payable issued by the Commonwealth of Pennsylvania's Department of Labor and Industry, Bureau of Workers' Compensation. It outlines the details regarding temporary compensation for an injured employee, including injury information, payment rates, and obligations for both the employer and employee. The notice serves as a formal communication regarding compensation for up to 90 days without admitting liability for the injury.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Date of Injury' and 'Date of Notice' in the designated fields. Ensure you select the correct month, day, and year.
Fill in the 'PA BWC Claim Number' if known, followed by the employee's details including first name, last name, address, city/town, state, zip code, county, and telephone number.
Next, provide employer information in a similar manner. Include their FEIN and contact details.
In the 'Injury Information' section, specify the body part(s) affected and type of injury. Describe the injury clearly for accurate processing.
Complete compensation details: enter weekly compensation rate based on average weekly wage and indicate when payments begin. Specify payment frequency (weekly/biweekly/other).
Finally, review all entries for accuracy before saving or sending your completed form.

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