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GS-97 NC Industrial

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North Carolina Industrial Commission

NOTICE OF TERMINATION OF COMPENSATION BY
REASON OF TRIAL RETURN TO WORK

G.S. § 97-18.1(b) AND G.S. § 97-32.1

The Use of This Form Is Required Under the Provisions of the Workers' Compensation Act

IC File #

Emp. Code #

Carrier Code #

Carrier File #

Employer FEIN

Employee's Name

Address

City

State

Zip

Home Telephone

Work Telephone

Last 4 Digits of SSN

Sex M F

Date of Birth

Employer's Name

Employer's Address

City

State

Zip

Insurance Carrier

Carrier's Address

City

State

Zip

Carrier's Telephone Number

Fax Number

Important Notice to Employee: Your disability compensation has been stopped because you have returned to work. You are entitled to a trial return to work for a period not to exceed nine months, unless you have been released by an authorized treating physician to unrestricted work, in which case your trial return to work may be limited to 45 days. During your trial return to work, you may be entitled to partial disability compensation if, because of your on-the-job injury, you earn less wages now than before your injury. In order to request that your compensation be reinstated if your trial return to work is unsuccessful, you should complete Form 28U, which may be obtained by calling (800) 688-8349. In addition, you should notify an appropriate person at the company named below in order to request that your compensation be reinstated:

NAME OF EMPLOYER OR CARRIER/ADMINISTRATOR

ADDRESS

TELEPHONE NUMBER

When an employee returns to work other than on a trial return to work basis [see I.C. Rule 404A(7)], Form 28 must be used.

EMPLOYER: COMPLETE THE FOLLOWING.

1. Date of injury: 2. Date disability began:

3. Date temporary total compensation was/will be terminated:

4. Date the employee returned/will return to work:

at the same or greater wages, than received at the time of injury, or

at reduced wages which were/are paid at the rate of $ weekly.

If employee has returned to work at reduced wages, is employee entitled to compensation for

partial disability pursuant to N.C. Gen. Stat. § 97-30? yes no

If "Yes", submit proper Form, such as Form 26 or Form 62

If not, explain:

5. If different employment has been verified, name of employer:

Address:

Telephone:

SIGNATURE OF EMPLOYER OR CARRIER/ADMINISTRATOR

TITLE

DATE

Employer: The original of this form shall be mailed to the address below, and a copy sent to the employee and the employee's attorney of record, if any. Form 28B must be filed to report the amount and last date compensation and/or medical compensation were paid.

FORM 28T

02/2017

PAGE 1 OF 1

FORM 28T

FILE VIA ELECTRONIC DOCUMENT FILING PORTAL

HTTP://WWW.IC.NC.GOV/DOCFILING.HTML

CONTACT INFORMATION:

NCIC-CLAIMS ADMINISTRATION

TELEPHONE: (919) 807-2502

HELPLINE: (800) 688-8349

WEBSITE: HTTP://WWW.IC.NC.GOV

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What the GS-97 NC Industrial document is and when it applies

The GS-97 NC Industrial is a standardized procedural document used in industrial contracting and compliance workflows in North Carolina. It collects project identifiers, party names, scope descriptions, and signature blocks to document approvals, safety compliance, and supply or service terms. Organizations use it to record contractual terms, certify inspections, and support regulatory audits. The form is typically completed by contractors, facility managers, or procurement staff and then retained according to federal and state recordkeeping rules to demonstrate compliance with tax, safety, and contract obligations.

Why a clear GS-97 NC Industrial matters for compliance and operations

A properly completed GS-97 NC Industrial creates a consistent, auditable record of industrial work, approvals, and responsibilities. That clarity reduces contract disputes, supports inspections, and streamlines internal approvals while ensuring required data is captured for tax and regulatory review.

Why a clear GS-97 NC Industrial matters for compliance and operations

Who commonly prepares and signs the GS-97 NC Industrial

Each party should complete only the sections that fall within their authority and sign in the designated signature block to preserve enforceability.

  • Contractors and subcontractors responsible for scope, materials, and on-site compliance during execution, providing technical details and signatures.
  • Procurement and project managers who verify scope, approve expenditures, and confirm vendor insurance and qualifications for contract records.
  • Safety officers and quality inspectors who attest to inspections, safety clearances, and compliance checkpoints required by regulators or internal policy.

Primary signers and their authority

Contracting Officer

A contracting officer or authorized procurement official is typically the party with delegated authority to bind the organization; they review terms, confirm funding availability, and sign to accept contractor performance obligations on behalf of the entity.

Company Signatory

An authorized company signatory (executive or delegated manager) must sign to accept responsibility for operational compliance and payment terms; the signer should be listed in corporate authorization records to avoid challenges to signature authority.

Step-by-step: complete, sign, and distribute the GS-97 NC Industrial

Follow these sequential steps to prepare, verify, and finalize the form for filing or internal recordkeeping.

  • 01
    Prepare Form: Populate project data, scope, amounts, and attachments clearly.
  • 02
    Verify Details: Confirm legal names, dates, and numeric entries with supporting documents.
  • 03
    Obtain Signatures: Collect required signatures in the order specified and record signer details.
  • 04
    Distribute Copies: Provide executed copies to finance, procurement, and the contractor for retention.

How to amend or revise the GS-97 NC Industrial

Use a controlled amendment process so changes remain auditable and agreed by all parties.

01

Propose Amendment:

Document changes in a redlined or replacement schedule and circulate to stakeholders.
02

Obtain Agreement:

All affected parties sign the amendment or initial changed pages to show consent.
03

Update Dates:

Set an effective amendment date and record it in the header or amendment clause.
04

Retain Prior Versions:

Keep earlier signed copies in the project file for audit trails and dispute resolution.
05

Distribute Revised Copy:

Send final executed amendment to finance, legal, and operational teams as applicable.
06

Archive Evidence:

Store amendment approvals and communications with the agreement for the retention period.

Suggested digital workflow settings for e-submission

Configure a controlled routing workflow to ensure each role reviews and signs in sequence and that audit data is captured.

Field Configuration
Authentication Email link, SMS code, or knowledge-based verification
Routing Sequential routing with required signers
Templates Save a reusable GS-97 template for consistency
Attachments Attach exhibits and certificates as PDF files

Typical eSubmission flow for the GS-97 NC Industrial

A concise online signing sequence reduces turnaround time and preserves an audit trail for each signer.

  • Upload: Upload the completed PDF or DOCX form to the signing platform.
  • Place Fields: Add signature, date, and text fields for each signer.
  • Authenticate: Choose email, SMS, or stronger verification as needed.
  • Capture Trail: The system records timestamps, IPs, and actions for auditability.

Technical considerations for eSigning and eSubmission

Ensure platform security and retention settings meet your legal and auditor requirements before finalizing eSubmission.

  • Integrations: Salesforce, NetSuite, Microsoft 365 integrations available
  • Formats: Accepts PDF, DOCX, and Excel formats
  • Authentication: Email, SMS, KBA, and SSO options supported

Core elements to include in a professional GS-97 NC Industrial form

Including standardized clauses and modular exhibits reduces ambiguity and supports enforceability across projects and audits.

Header Data

Clear project identifier, contract number, and version control help auditors map the form to procurement records and avoid misfiling across multiple project phases.

Scope of Work

A detailed, itemized scope that references specifications, drawings, or schedules reduces disputes and provides a measurable basis for inspections and acceptance testing.

Payment Terms

Explicit payment milestones, invoicing instructions, and retainage conditions speed accounting reconciliation and reduce the risk of late or disputed payments.

Safety and Compliance

Include required safety certifications, insurance minimums, and regulatory adherence clauses so the form supports compliance reviews and inspection readiness.

Signatures

Designate signature blocks with printed name, title, date, and representative authority language to avoid later challenges to execution validity.

Attachments

Reference and attach exhibits such as drawings, certificates, and inspection reports to ensure all contract elements are consolidated and available during audits.

Supporting materials to bundle with each completed GS-97 NC Industrial form

Consistent supporting documentation ensures the completed form is actionable and auditable for finance, legal, and regulatory review.

Insurance Certificates

Attach current insurance and bonding certificates referenced by the contract.

Scope Exhibits

Include drawings, specs, and work schedules as appendices.

Inspection Reports

Attach any preliminary or final inspection evidence.

Change Orders

Include executed change orders referenced by the GS-97 form.

Best practices to reduce errors and speed approvals

Adopt simple controls and verification checks before signatures to prevent rework and compliance gaps.

Use a standard template
Maintain a single approved GS-97 template with version control and a changelog; training reduces inconsistent field entries and accelerates reviewer familiarity.
Validate names and TINs
Confirm legal entity names and taxpayer identification numbers against official records; mismatched TINs can trigger backup withholding or tax reporting delays.
Require checklist signoff
Add a brief reviewer checklist to the workflow to confirm insurance, permits, and safety signoffs before final signature to avoid downstream compliance exceptions.
Capture full audit data
Preserve timestamps, IP addresses, attachment hashes, and signer authentication evidence to support audits and litigation defensibility.

Key milestones from drafting to retention

Track progress through drafting, review, execution, and filing so each milestone is auditable and scheduled.

01

Drafting

Prepare the initial GS-97 and attach exhibits for stakeholder review.

02

Internal Review

Procurement, legal, and safety review and initial approvals occur before signature routing.

03

Execution

All required parties sign; record the effective date and retain executed copies.

04

Archival

Store signed records and supporting evidence according to retention policy and legal requirements.

Timing considerations and typical submission windows

Timing varies by contract and agency; confirm specific deadlines in procurement documents or sponsor instructions.

Award-related filing:

Submit executed GS-97 as required by the award or purchase order terms.

Invoice alignment:

Ensure GS-97 execution precedes invoice submission when contract conditions require.

Regulatory review:

Provide documents to inspectors within the timeline defined by the regulating agency.

Amendment windows:

Process revisions promptly and circulate amendments to all signers for agreement.

Audit production:

Be prepared to produce executed records within auditor-requested timeframes.

Common preparation errors to avoid

  • Mismatched names or taxpayer identification numbers: failing to mirror corporate or W-9 records commonly triggers withholding or reporting corrections and administrative delays.
  • Incomplete attachments or exhibits: omitting referenced drawings, certificates, or schedules can make the form non-actionable and require resubmission.
  • Unsigned or partially signed pages: leaving pages unsigned or relying on initials where full signatures are required can invalidate the agreement in practice.
  • Incorrect dates or effective terms: ambiguous or conflicting dates create disputes about obligations, warranties, and deadlines during performance or closeout.

Consequences of incorrect or late GS-97 NC Industrial filings

1099 Reporting: $60 per form (late within 30 days)
1099 Reporting II: $130 per form (late after 30 days)
1099 Serious Late: $330 per form (late after August 1)
Intentional Disregard: $660+ per form, no cap
I-9 Paperwork: $281–$2,789 per violation
Contract Risk: Payment delays or disputes due to missing signatures

Security and compliance checkpoints to include

Encryption: TLS 1.2/1.3; AES-256 at rest
Certifications: SOC 2 Type II; ISO 27001
Health Data: HIPAA compliant (BAA required)
Federal eSign: ESIGN and UETA recognition
Accessibility: WCAG 2.0 Level AA support
Audit Trail: Immutable timestamps and action logs

Real-world examples of digital signing and compliance workflows

These brief examples show how other organizations use digital workflows to handle similar industrial documents.

Optica Ventures (COO)

Optica centralized document routing to reduce manual handoffs and ensure consistency.

  • The interface required minimal training.
  • The result was faster turnaround across vendor approvals and fewer missing exhibits during audit-ready deliveries, improving overall operational predictability.

Fertility Centers of Illinois (Founder)

The organization adopted structured digital signing to standardize consent and administrative records.

  • The API integration automated record storage.
  • The approach lowered retrieval times for patient records during audits and supported secure, auditable access when regulatory reviews occurred.

How the GS-97 NC Industrial differs from other common industrial templates

Comparison highlights how scope, signature requirements, and exhibits distinguish this form from other industrial or procurement documents.

Criteria GS-97 NC Industrial Standard Purchase Order
Purpose project certification goods procurement
Signature Needs multiple authorized signers single approver typical
Exhibits Included technical schedules and inspections price sheets and delivery terms
Retention Focus compliance and inspection records accounting records

Representative eSignature pricing and capability snapshot for GS-97 NC Industrial workflows

Compare common vendor pricing and basic capabilities relevant to high-volume industrial signing. Do not treat the table as an exhaustive feature matrix.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial Yes, 7-day trial No No Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

FAQs and troubleshooting for common GS-97 NC Industrial issues

Answers to frequent questions about signature validity, corrections, notarization, and digital submission for this form.


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