Get Department Of Labor Wage Schedule - Nh.gov - Nh

The Department of Labor Wage Schedule is an essential document for reporting employee wages, particularly in cases of disability due to industrial accidents. This guide outlines the steps to accurately fill out the form online, ensuring compliance while providing clear instructions for each relevant section.

Follow the steps to complete the wage schedule effectively.

1. Press the ‘Get Form’ button to access the wage schedule form and open it in your preferred document editor.
2. Begin by entering the employee's name in the designated space labeled 'Employee.'
3. Fill in the 'Date of hire' to indicate when the employee started working.
4. In the 'Avg. wkly. earnings' field, provide a calculation of the average weekly earnings for the employee.
5. Enter the employer's name in the 'Employer' section, making sure it matches official records.
6. Complete the employer's address, ensuring you include the street number, city, and state.
7. Take note of the requirement that the employer must send copies of the wage schedule and the supplemental report form to the insurance carrier no later than the fifteenth day of the employee’s disability.
8. Fill in the gross earnings, other advantages, and total in the provided columns (labeled 1, 2, and 3).
9. Ensure to describe any advantages beyond monetary compensation, such as board or lodging, in the 'Other advantages' section.
10. In weeks where no wages were earned, provide a brief explanation in the specified area.
11. Complete any remaining fields as necessary, ensuring all data entries are accurate and relevant.
12. Finalize the form by including the carrier's name and the employer's signature. Make sure to provide the employer’s address as well.
13. Obtain the department's approval signature and date on the form before submitting.
14. Once all fields are complete, save your changes, and ensure to download, print, or share the completed form as needed.

We encourage you to complete the wage schedule and other related documents online for a streamlined process.