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The Workers Compensation Waiver Form is utilized when employers and employees need to document the voluntary waiver of specific non-statutory compensation benefits. This document, governed by English and Welsh law, is particularly relevant in high-risk industries or when alternative compensation arrangements are being made. It must carefully navigate the complex landscape of employment law, ensuring that statutory rights remain protected while allowing flexibility in voluntary benefits. The form typically includes detailed information about the specific benefits being waived, alternative arrangements if any, and clear statements about preserved statutory rights.

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