Carnegie, PA · Allegheny County
Workers’ Compensation Affidavit
This affidavit states whether a permit applicant will hire others for a project and is filed by the applicant seeking a Borough permit.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The Workers’ Compensation Affidavit records the applicant’s statement that they will not employ or hire other people for the project for which they are seeking a permit. It also explains that, if the applicant hires others after receiving the permit, they must notify Borough officials and provide proof of workers’ compensation coverage. The form warns that failure to comply may result in a stop-work order that remains in effect until proper coverage is obtained.
Who needs it
A person applying for a Borough permit who states they will not hire others for the project should complete and file this affidavit.
Why it needs a notary
The applicant signs before a notary, who completes the subscribed-and-sworn jurat with the date, county, signature, seal, and commission expiration.
How to get this notarized
- 1
Download the Affidavit
Get the Workers’ Compensation Affidavit from the Borough of Carnegie.
- 2
Complete the Form
Enter your printed name and review the statement about hiring others for the permitted project.
- 3
Book an Online Notary
Schedule a remote session with a commissioned online notary.
- 4
- 5
Submit to the Borough
Submit the notarized affidavit with your permit materials to the Borough of Carnegie.
Preview the form
The blank PDF straight from Carnegie. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I notarize the Workers’ Compensation Affidavit online?
- Complete the form but wait to sign. Book with a commissioned online notary, show identification, and sign during the video session. Pennsylvania authorizes remote online notarization for its own notaries under 57 Pa.C.S. §306.1.
- Do I need to notarize this affidavit before submitting it?
- Yes. The form has a subscribed-and-sworn jurat for the notary, and the applicant must sign before the notary. Submit the completed affidavit with your permit materials to the Borough.
- What if I hire someone after receiving the permit?
- The affidavit says you must notify Borough officials and provide proof of workers’ compensation coverage if you employ others after receiving the permit. It warns that failure to comply may result in a stop-work order.
- Can I submit the notarized form online?
- The form does not specify how to submit it. Ask the Borough about its submission process; confirm with the city, borough or township if unsure.
Workers’ Compensation Affidavit in other Pennsylvania cities
Each city publishes its own version of this form. Pick the city where you’re filing.