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Get and Sign C240 Form 2011

Get and Sign C240 Form 2011

Use a C240 Form 2011 template to make your document workflow more streamlined.

Service during the 52 week period immediately preceding the date of accident? Yes No If "Yes", give date of discharge INSTRUCTIONS: 1. Give gross weekly earnings for the 52 weekly periods immediately preceding the date of accident. 2. If injured employee has not worked at the same work for a year or a substantial part thereof (234 days for a 5 day week, 270 days for a 6 day week) give the weekly gross earning of another employee of the same class who has worked for a year or a substantial...
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