Wage Request Form 2026

1. Click ‘Get Form’ to open the Wage Request Form in the editor.
2. Begin by entering the worker's name and SAIF claim number at the top of the form. This information is crucial for identifying the request.
3. Fill in the date of injury, ensuring accuracy as it relates to wage calculations.
4. In the gross wages section, provide details for pay periods from the 52 weeks prior to the injury date. Exclude any tool rental amounts.
5. Note any rate changes and include rates used for sick or vacation time in their respective fields.
6. If applicable, indicate whether other considerations such as subsistence or travel pay are received, and specify amounts and payment frequency.
7. Indicate union membership status and provide local union details if applicable.
8. Complete employment start date, pay period dates, hours worked, base pay rate, overtime details, and any other gross earnings with explanations as needed.
9. Finally, ensure that the preparer’s name and title are printed clearly, sign the form, and include a contact telephone number before submission.

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