Form Aww 1 PDF Details

In the realm of workers' compensation, the calculation of an individual’s earnings is pivotal. Introduced on January 1, 1997, by the Kentucky Department of Workers Claims, the Form AWW-1 serves a critical function in this process. Specifically, it is designed to certify an employee’s Average Weekly Wage, providing a detailed accounting of their earnings before any injury or exposure. This certification is foundational for determining the compensation benefits an injured employee is entitled to. The form captures various employment and compensation details, including the date of the injury or exposure, the method of wage payment (spanning hourly to yearly salaries, including output of employee), the date of hire, and employment status (which encompasses options from part-time to apprentice/trainee). Additionally, it accounts for supplementary forms of compensation such as board, lodging, or fuel, when provided by the employer, along with the employee’s potential overtime work, gratuities, and paid vacations or holidays. This comprehensive approach ensures that all facets of an individual’s wage are considered, allowing for a more accurate calculation of the benefits due. Ultimately, the AWW-1 form's meticulously structured sections facilitate a rigorous certification process, underscoring its significance in upholding the integrity of workers' compensation claims.

QuestionAnswer
Form NameForm Aww 1
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesaww 1, ky aww, form aww, wage weeks certification

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Form AWW-1

Average Weekly Wage Certification

Adopted January 1, 1997

KENTUCKY

DEPARTMENT OF WORKERS CLAIMS

CLAIM NUMBER

PLAINTIFF

VS

WAGE CERTIFICATION

DEFENDANTS

1.Date of Injury/Exposure as reported on Form 101/102/103:

2.Method of Wage Payment (check one):

Hourly

Daily

Weekly Salary

Monthly Salary

Yearly Salary

Output of Employee

3.Date of Hire or Employment:

4.Status or Classification of Employment (check one):

Part-time

Full-time

Probationary

Seasonal

Volunteer

Apprentice/Trainee

5.Did Employer provide any of the following (check appropriate ones):

Board

Rent Housing

Lodging

Fuel

6.Did Employee (check appropriate ones):

Work Overtime

Receive Gratuities Paid Vacations/Holidays

Claimant's Name:

Claim Number:

Weeks Worked

# of Regular

# of Overtime

Regular

 

 

Weekly Wage

 

Month/Day/Year

 

Hours Worked

 

Hours Worked

 

 

Hourly Rate

 

 

 

 

1.

 

 

+

 

 

x

 

 

=

 

 

2.

 

 

+

 

 

x

 

 

=

 

 

3.

 

 

+

 

 

x

 

 

=

 

 

4.

 

 

+

 

 

x

 

 

=

 

 

5.

 

 

+

 

 

x

 

 

=

 

 

6.

 

 

+

 

 

x

 

 

=

 

 

7.

 

 

+

 

 

x

 

 

=

 

 

8.

 

 

+

 

 

x

 

 

=

 

 

9.

 

 

+

 

 

x

 

 

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10.

 

 

+

 

 

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11.

 

 

+

 

 

x

 

 

=

 

 

12.

 

 

+

 

 

x

 

 

=

 

 

13.

 

 

+

 

 

x

 

 

=

 

 

 

 

 

 

 

Total:

 

$

 

 

 

 

 

÷ By 13 weeks

 

 

 

 

 

=

 

 

$

14.

 

+

 

x

 

 

=

 

15.

 

+

 

x

 

 

=

 

16.

 

+

 

x

 

 

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19.

 

+

 

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20.

 

+

 

x

 

 

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21.

 

+

 

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22.

 

+

 

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23.

 

+

 

x

 

 

=

 

24.

 

+

 

x

 

 

=

 

25.

 

+

 

x

 

 

=

 

26.

 

+

 

x

 

 

=

 

 

 

 

 

 

Total:

 

$

 

 

 

 

 

÷ By 13 weeks

 

 

 

 

 

=

 

 

$

Claimant's Name:

Claim Number:

Weeks Worked

# of Regular

# of Overtime

Regular

 

 

Weekly Wage

 

Month/Day/Year

 

Hours Worked

 

Hours Worked

 

 

Hourly Rate

 

 

 

 

27.

 

 

+

 

 

x

 

 

=

 

 

28.

 

 

+

 

 

x

 

 

=

 

 

29.

 

 

+

 

 

x

 

 

=

 

 

30.

 

 

+

 

 

x

 

 

=

 

 

31.

 

 

+

 

 

x

 

 

=

 

 

32.

 

 

+

 

 

x

 

 

=

 

 

33.

 

 

+

 

 

x

 

 

=

 

 

34.

 

 

+

 

 

x

 

 

=

 

 

35.

 

 

+

 

 

x

 

 

=

 

 

36.

 

 

+

 

 

x

 

 

=

 

 

37.

 

 

+

 

 

x

 

 

=

 

 

38.

 

 

+

 

 

x

 

 

=

 

 

39.

 

 

+

 

 

x

 

 

=

 

 

 

 

 

 

 

Total:

 

$

 

 

 

 

 

÷ By 13 weeks

 

 

 

 

 

=

 

 

$

40.

 

+

 

x

 

 

=

 

41.

 

+

 

x

 

 

=

 

42.

 

+

 

x

 

 

=

 

43.

 

+

 

x

 

 

=

 

44.

 

+

 

x

 

 

=

 

45.

 

+

 

x

 

 

=

 

46.

 

+

 

x

 

 

=

 

47.

 

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x

 

 

=

 

48.

 

+

 

x

 

 

=

 

49.

 

+

 

x

 

 

=

 

50.

 

+

 

x

 

 

=

 

51.

 

+

 

x

 

 

=

 

52.

 

+

 

x

 

 

=

 

 

 

 

 

 

Total:

 

$

 

 

 

 

 

÷ By 13 weeks

 

 

 

 

 

=

 

 

$

CERTIFICATION

I hereby certify that the above wage information is a true and accurate accounting of the

wages of (claimant's name)from the date of employment or fifty-two weeks prior to the date of the injury/last exposure as set forth in the Form 101/102/103, whichever is shorter.

 

 

 

 

Name of Company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

CERTIFICATE

 

 

 

 

It is hereby certified that the original of this wage certification was mailed this

 

day

of

 

, 20__ to the Commissioner and a copy of the same to Counsel of record and

the assigned Administrative Law Judge.

 

 

Attorney for Defendant Employer

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Part # 1 of filling out ky aww

2. Right after performing the last step, go to the subsequent part and fill in the essential particulars in all these fields - Yearly Salary, Output of Employee, Date of Hire or Employment, Status or Classification of, Parttime Fulltime Probationary, Seasonal Volunteer, Did Employer provide any of the, Board, Rent, Housing, Lodging Fuel, Did Employee check appropriate ones, and Work Overtime Receive Gratuities.

Step # 2 in filling in ky aww

Lots of people often get some things wrong while filling in Rent in this part. Remember to read again what you enter right here.

3. The following step focuses on Claimants Name, Claim Number, Weeks Worked MonthDayYear, of Regular Hours Worked, of Overtime Hours Worked, Regular Hourly Rate, Weekly Wage, and x x x x x x x x x - fill out each of these empty form fields.

Tips on how to fill in ky aww step 3

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