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Workers Compensation Waiver Form
"I need a Workers Compensation Waiver Form for our manufacturing company's new alternative benefits package, which will take effect from March 2025, covering approximately 200 employees across three factory locations in Wales."
1. Employee Information: Full details of the employee including name, address, and employment details
2. Employer Information: Company details and registered address
3. Statement of Understanding: Employee's acknowledgment of understanding the waiver and reference to relevant legislation including Health and Safety at Work Act 1974 and Employers' Liability Act 1969
4. Scope of Waiver: Specific benefits or rights being waived, with clear limitations and explicit mention of non-waivable statutory rights
5. Statutory Rights Notice: Clear statement that statutory rights cannot be waived, with reference to relevant legislation
6. Signature Block: Space for dated signatures of all parties and witness signatures if required
1. Alternative Benefits: Details of any alternative compensation or benefits being offered in lieu of standard workers compensation
2. Time Limitation: Period for which the waiver is valid, including any specific start and end dates
3. Revocation Rights: Terms under which the waiver can be revoked and the process for doing so
1. Schedule 1: Statutory Benefits Summary: Comprehensive summary of statutory benefits that cannot be waived under English law
2. Schedule 2: Alternative Benefits Package: Detailed description of alternative benefits offered, including terms and conditions
3. Appendix A: Risk Assessment: Workplace risk assessment related to the waiver and compliance with Health and Safety regulations
Authors
Applicable Law
Benefits
Claim
Compensation
Effective Date
Employer
Employee/Worker
Employment Contract
Insurance Coverage
Mandatory Benefits
Non-Statutory Benefits
Parties
Statutory Benefits
Statutory Rights
Term
Voluntary Benefits
Waiver
Waived Benefits
Workplace
Work-Related Injury
Workers Compensation
Working Hours
Written Notice
Alternative Benefits
Binding Effect
Capacity to Enter Agreement
Consideration
Duration
Entire Agreement
Governing Law
Insurance Coverage
Legal Rights Preservation
Non-Statutory Benefits Waiver
Notice Requirements
Revocation Rights
Scope of Waiver
Severability
Statutory Rights Preservation
Term and Termination
Voluntary Nature of Waiver
Waiver Limitations
Witness Requirements
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