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If the employee had more than one employer at the time of injury, a separate Statement of Wages form must be completed for each employer. (TOLL FREE) 800-482-2383.Reenacted and Amended June 21, 1939, P.L.520, No.281. View on Westlaw or start a FREE TRIAL today, § 12. Form of statement of wages for injuries occurring on and after June 24, 1996, Secondary Sources. For injuries occurring on or before June 23, 1996, the form LIBC-494A (Statement of Wages) must be completed. Documentation, maintenance of complete and accurate records of wages paid. -137. What must an employee do when an injury occurs? Report the injury to the employer, orally and in writing, immediately and in any event within 30 days. The UEF applies only to injuries occurring on or after July 1, 1996.