WLUSA Supplemental Pay Form
Employee Name: ___________________________
Employee ID: _____________________________
Compensation (in hours)
Comments
Date
Shift
Overtime
Call Back
Worked
Premium
# of
OnOTP
(DD/MM/YY) worked
(indicate
Call
OTB
OTB
OTB
OTP
OTP
CBK @ CBK @
hours
hours per day
@
@ 1 @ 1.5 @ 2.0 @ 1
@2
1.5
2
or week)
1.5
Total
Employee Signature
Date
Manager Signature
Legend
OTB– overtime hours to be banked at 1.5 x hours OR 2.0 x hours
OTP – overtime hours to be paid at 1.5 times regular rate OR 2.0 x regular rate
Shift Premium – hours for which shift premiums are to be paid
On-call – hours for which on-call premiums are to be paid
Call back – hours for which call back premiums are to be paid at 1.5 x regular rate
Call back – hours for which call back premiums are to be paid at 2 x regular rate
Please refer to your Collective Agreement to ensure the correct Compensation category is used.
Jan‐16 Date
Article Reference
23.5.2
23.5.2
23.6
23.9
23.10.3
23.5.2.(ii)
Directions for completion of WLUSA Supplemental Pay Form Date Worked Enter the date the work was performed # Actual Hours Worked Enter the Actual hours worked OTB @1 OTB @ 1.5 OTB @ 2 OTP @ 1 OTP @ 1.5 OTP @ 2 Overtime Banked (OTB) hours are banked at Regular Rate enter the number of overtime hours to be banked at straight time ie: over time worked = 1 hour Overtime to be banked = (1 x 1) 1 hours will be added to bank Overtime to be banked = 1.5 (1 x 1.5) 1.5 hours will be added to bank Overtime to be banked = 2 (1 x 2) 2 hours will be added to bank enter the number of overtime hours to be banked ie: over time worked = 1 hour enter the number of overtime hours to be banked ie: over time worked = 1 hour Overtime Paid (OTP) hours are paid at Regular Rate enter the actual hours worked enter the actual hours worked multiplied by 1.5 enter the actual hours worked multiplied by 2 Shift Premium report shift premiums to payroll in one of two ways: i‐ enter the number of hours for each day ii‐enter the range of dates in the Date Worked column and identify how many hours of shift premium per day On Call enter the number of hours to be paid for On Call CBK @ 1.5 CBK @ 2 Call Back hours are paid at Premium Rate If hours worked < 1, enter 1. When hours >= 1 enter the actual worked hours. If hours worked < 1, enter 1. When hours >= 1 enter the actual worked hours. Comments provide any further directions for Payroll ie ‐ charge to another department Keep copies for Department/Employee Records