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 Word template that can be filled out on your computer (if you have Microsoft Word).  If you do not have Microsoft Word we are providing a PDF (WKC-7359) which you can print and complete by hand.

Content Contact:  Kathy Froehlich

Document Attachments:

WKC-7359-E (Electronic Version - Excel/86 KB)

WKC-7359 (Print Version - pdf/52 KB)

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page.  Links to each specific vendor's site have been provided for you.  Thank you.