Workers’ Compensation Payroll Audit Form

Audit period June 1, 2019 - May 31, 2020
  • (for wages reported below; do not include volunteers)
  • NEW DEADLINE: July 15, 2020

    Due to an additional data request (forthcoming from Church Mutual), the deadline has been extended this year. This form must be returned to the Finance Office by July 15, 2020. Please enter the gross payroll figures for each classification code for the period June 1, 2019 to May 31, 2020 and return. (We will send the additional detail request for wage info related to COVID-19 when we receive from Church Mutual.)
  • Gross Payroll Amount

    Please enter the gross payroll figures for each classification code below using the period of June 1, 2019 to May 31, 2020.
  • 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.

    **The annual Workers’ Compensation Audit form must be returned to the Office of Administration no later than July 15, 2020. 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.