Georgia wage 2026

The document is a Wage Statement from the Georgia State Board of Workers' Compensation, used to report an employee's earnings and compute their average weekly wage following a workplace injury. It includes sections for identifying information, computation of average weekly wage based on the employee's earnings over the thirteen weeks prior to the injury, and a schedule for detailing weekly earnings, including any additional compensation. The document also warns against making false statements regarding benefits.

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Click ‘Get Form’ to open the Georgia Wage Statement in the editor.
Begin by filling in the Identifying Information section. Enter the Employee Name, Social Security Number, Address, Date of Injury, County of Injury, City, Zip Code, State, Employer Name, and Employer Address.
Proceed to the Computation of Average Weekly Wage section. If applicable, complete the schedule for the thirteen weeks preceding the accident. If not employed for that duration, provide gross weekly earnings of a similar employee and their name.
Fill in Hours Worked and Number of Days Worked Per Week. Specify the Wage at Date of Injury per day and per week.
Complete the Schedule of Weekly Earnings by entering details for each week including dates worked, gross amount paid (including overtime), and any additional compensation such as meals or lodging.
Finally, review your entries for accuracy before signing and dating the form at the bottom.

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