Workers’ Compensation Payroll Audit Form

Audit period June 1, 2018 - May 31, 2019
  • (for wages reported below; do not include volunteers)
  • NEW DEADLINE: June 20, 2019

    This form must be returned to the Office of Administration by June 20, 2019. We have a new deadline to report to Catholic Mutual.
  • Gross Payroll Amount

    Please enter the gross payroll figures for each classification code below using the period of June 1, 2018 to May 31, 2019.
  • 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.
  • IMPORTANT

    **The annual Workers’ Compensation Audit form must be returned to the Office of Administration no later than June 20, 2019. The form should be returned even if there are no workers or wages to report, just write “nothing to report.” THANK YOU!!
  • This field is for validation purposes and should be left unchanged.