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Record of earnings/claim for incapacity for work—Statement of hours worked and gross weekly earnings in paid employment


This form is to be used when you are required to provide a statement of paid employment while claiming compensation for time off work or/and reduced earnings from Comcare.

Available formats

Last updated: October 2014

If you would like to request this publication in a different format to what is available for download (above), or the publication is not currently available for download, please refer to:

Page last updated: 17 Aug 2015