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Employee statement form

Employee statement form 2025

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The document outlines the procedure for injured employees at the NC Department of Administration to report workplace injuries and select leave options. It requires employees to provide detailed information about the incident and their injury, after which supervisors complete a section and forward it to the appropriate personnel. Employees can choose from various leave options related to their workers' compensation claims, with specific conditions regarding sick or vacation leave.

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Click ‘Get Form’ to open the employee statement form in the editor.
Begin by entering your personal information in the designated fields, including your name, personnel number, department, division/unit, location, county, date of injury, and date injury was reported.
In the 'Description of Accident' section, provide a detailed account of the incident. Be as specific as possible to ensure clarity.
Indicate the part(s) of your body that were injured and describe the cause of the accident in the respective fields.
Review your statements for accuracy. Once satisfied, sign and date the form at the bottom to confirm that all information is true and accurate.
For leave options, select your desired option by placing an X in the appropriate box. Ensure you understand each option's implications before making a selection.
After completing your section, submit it for supervisor review. The supervisor will complete their section and forward it accordingly.

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What does an employee statement look like?

This statement typically includes information such as the employees job title, salary or hourly rate, working hours, duties, benefits, and other important employment details. The statement serves as a formal record of the employment agreement and can be used for reference by both the employee and employer.

What is the employee written statement?

A written statement summarises the main terms of employment, such as pay and working hours. Many people think this document is the employment contract. However legally the contract is much broader than the written statement.

What is an employee statement?

If your state isnt one that requires your employer to automatically provide a statement, youll have to request one. Contact the human resources or accounting departments at your place of work to do so. Theyll be able to walk you through the steps that your employer requires for you to get access to your records.

How to write an employee statement?

How to Write a Simple Statement to Your Employees Address your employee in a professional way. Start your statement that gets to direct point. Elaborate your statement but make it concise. Offer to answer the questions that your employees may have. Thank your employees. End your statement in a professional way.

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