The documents below are relevant to employers.
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Completed Wage Chart (8+ Days)

Example of a Wage Chart where an 8-day gap is involved. This could include weeks that an employee was off payroll for unpaid leave for various reasons.

These periods should be noted on the chart using an asterisk (*) in the “Gross amount paid, including overtime” column and are not to be counted in the calculations.

Completed Wage Chart

Example of a Wage Chart properly completed for a 52 week period preceding the accident.
Complete the weekly gross wages, number of days worked and the week ending date for the full 52 weeks, or applicable number of weeks available prior to the date of accident. Earnings for a similar employee may be used if the employee has worked less than 60 days.