Wage Chart (Form 7A)
VWC Form
Description
The Wage Chart should be used to determine the injured worker’s pre-injury average weekly wage based on the applicable 52 weeks immediately preceding the date of accident. Note that these earnings are GROSS earnings and include overtime and tips, before any deductions are made for taxes or Social Security. If there were any perquisites, please list the TOTAL value separately at the bottom of the chart. If the injured worker has worked less than 12 months, the earnings for the time worked should be used. The earnings for a similar employee may be used if the injured worker has worked for less than 60 days. The forms should be clear and legible or they may be returned to the insurer.
Instructions
This form should be completed by the employer/insurer and should list weekly gross wages for the applicable weeks available. If an injured worker lost more than seven consecutive calendar days, although not in the same week, these periods should be noted on the Wage Chart (VWC Form No. 7-A) using an asterisk in the Week No. column and are not to be counted in the calculations. Virginia Code § 65.2-101.
For questions, please contact the Commission toll-free at 1-877-664-2566 or by email at Questions@workcomp.virginia.gov.