Temporary Partial Disability Worksheet

Document Number: WKC-7359-E

Description: TPD earnings are to be submitted through the internet. The WKC-13 and this worksheet will assist you in calculating temporary partial disability when you need to submit physical TPD information only. Instructions for using this form are included on the same page as the form itself and appear between the upper area of claim information and the lower worksheet area.

Comments: This form is an electronic Microsoft Excel template that can be filled out on your computer (if you have Microsoft Excel). If you do not have Microsoft Excel we are providing a PDF (WKC-7359) which you can print and complete by hand.

Content Contact: Lynn Weinberger

Document Attachments:

WKC-7359-E (Electronic Version - Excel/104 KB)

WKC-7359 (Print Version - pdf/113 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.