Workers’ Compensation Payroll Audit Form

Workers Compensation Payroll Audit

Audit period June 1, 2025 - May 31, 2026

  • This field is for validation purposes and should be left unchanged.
  • (for wages reported below; do not include volunteers)

  • DEADLINE: July 10, 2026

  • Gross Payroll Amount

    Please enter the gross payroll figures for each classification code below using the period of June 1, 2025 to May 31, 2026.
  • Church and/or school professional (ex: Priest, Religious, Pastoral ministers, teachers, substitute teachers, coaches, organist, choir directors, administrative/clerical staff)
  • Other church and/or school non-professionals (ex: janitors, maintenance workers)
  • Drivers (ex: school buses, vans, etc.)
  • Retail (ex: St. Vincent de Paul Stores)
  • Cemetery employees other than clerical (ex: opening graves, removing and reinterring remains, drivers)
  • Clerical, not involved in Religious Institutions (ex: cemetery, nursing homes, St Vincent de Paul)
  • Retirement Living Centers (ex: Healthcare workers)
  • Social Services Organizations (ex: all employees, salespersons and drivers - St. Benedict Shelter & St. Gerard’s)

  • Preparer of the Form

    Please provide a current email address, as this form will again be emailed to everyone each year.