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  1. Add: Click here first to open the dialog box to add the plaintiff employment information.

  2. Plaintiff: Dropdown; plaintiff who is employed

  3. Employer Name: Contact-list dropdown; the employer

  4. Date From: Date-widget dropdown; the date the plaintiff began this employment.

  5. Date To: Date-widget dropdown; the date the plaintiff ended this employment.

  6. Status: Dropdown; the status of the plaintiff’s employment.

  7. Work site: Contact-list dropdown; the address of the work-site.

  8. Job Title: Text field. Enter the plaintiff’s job title.

  9. Department: Text field. Enter the department the plaintiff works in.

  10. Trade: Dropdown; the plaintiff’s trade.

  11. Contact Person Name: Contact-list dropdown; the contact person at the place of employment.

  12. Union: Contact-list dropdown; the union the plaintiff belongs to.

  13. W/C Claim: Check this box if there is a worker’s compensation claim related to this incident.

  14. Employer Comments: Enter comments applicable to the employer.

  15. Salary: Text field. Enter the amount of the payment for salary. Salary Frequency: Dropdown; the frequency of the payments for salary.

  16. Commission: Text field. Enter the amount of the payment for commissions. Commission Frequency: Dropdown; the frequency of the payments for commissions.

  17. Bonus: Text field. Enter the amount of the payment for bonuses. Bonus Frequency: Dropdown; the frequency of the payments for bonuses.

  18. Over Time: Text field. Enter the amount of the payment for over time. Over Time Frequency: Dropdown; the frequency of the payments for over time.

  19. Other Compensation: Text field. Enter the amount of the payment for other compensation. Other Compensation Frequency: Dropdown; the frequency of the payments for other compensation.

  20. Temporary Total Disability: Text field. Enter the temporary total disability. Average Weekly Wage: Text field. Enter the average weekly wage.

  21. Compensation Comments: Enter comments applicable to compensation.

  22. Continuing?

  23. Works off the books: Check this box if client works off the books.

  24. Works partially off the books: Check this box if client works partially off the books

  25. Authorization to defense counsel: Date authorization was sent to defense. Authorization check box if sent

  26. Employment Verification Request: Date employment verification request was sent. Date verification request was received.

  27. Save: Once all the employment and compensation information has been entered, click update to save the information.

Lost Wages Table

Payments/Adjustments Table