Workers’ Compensation
UCLA Healthcare
June 6, 2003
1
What Is the Purpose of Workers’
Compensation?
To provide legally mandated benefits
to
workers who are injured at work
or
who develop a job-related illness as a
result of their employment
Benefits may include payment for medical
bills, mileage, lost wages and vocational
rehabilitation
2
Who Administers and Pays for
Workers’ Compensation?
UC is self-insured and has selected Octagon Risk
Services, an independent contractor, to administer our
workers’ compensation claims.
Octagon Risk Services may discuss the claim with the
department and the employee, investigate the
injury/illness, and determine what workers’ compensation
benefits the employee will receive.
Funding for the Workers’ Comp program is provided by
the UC locations as a group. Each UC location is charged
a premium amount per $100 of payroll
based on the location’s overall claim
performance.
3
When an Employee Is Injured
on the Job . . .
Provide the employee with:
1. A completed EMPLOYEE’S CLAIM FORM FOR WORKERS’
COMPENSATION BENEFITS
This form must be provided within 24 hours of receipt of notice
that an injury or illness has occurred as mandated by California
state law. (Exception: first aid incidents)
2. A completed EMPLOYEE’S REFERRAL SLIP FOR
INDUSTRIAL INJURY AND REPORT OF ACCIDENT
3. UCLA WORKERS’ COMPENSATION BOOKLET WHEN AN
INJURY OCCURS & Workers’ Compensation Instruction Sheet
4
Employee’s Claim For Workers’
Compensation Benefits
Instructions on how to complete the Employee’s Claim
Form for Workers’ Compensation Benefits
1a. If the employee notifies you in person, the supervisor or
department personnel representative must fill out lines 1, 9, 10, 11,
12, 13, 16, 17, 18
Have employee sign on line 8. Continue to step 2
–
–
The employee may fill out the “employee” section of the claim form in your
presence and return the form to you
If the employee chooses to fill out the “employee” section on their own,
instruct them to mail the completed form to Healthcare HR
1b. If you receive notice of the employee’s injury by phone:
supervisor fills out lines 1, 9, 10, 11, 12, 16, 17, 18. On line 11, fill
in the date supervisor received phone report of injury. On line 12,
fill in the date form was mailed to the employee
– Certified mail is advisable as proof of mailing
– Continue to step 2
5
Employee’s Claim For Workers’
Compensation Benefits (Cont’d)
2.
Make a copy of the Claim Form and proof of mailing form for the
department’s records. Department keeps the 5th copy “Employers’
Temporary Receipt” for department records.
3.
Immediately FAX a copy of the completed form
to the WC FAX line x 40530.
4
Employee keeps the 4th copy “Employee’s Temporary Receipt.”
5.
Send all other copies of the form immediately to Healthcare HR
for further distribution.
6.
Notify Healthcare HR Workers’ Comp x40522 or via
email to Cynthia Vazquez as soon as you are aware
that an employee has been taken off work.
6
Employee’s Referral Slip For Industrial
Injury And Report Of Accident
Instructions on how to complete the Employee’s Referral
Slip for Industrial Injury and Report of Accident.
1.
Supervisor is responsible to complete this form describing how the injury
occurred and where. Note the date the injury was reported.
2.
Send the employee to the Occupational Health Facility with the Referral
Slip. If OHF is closed, direct the employee to the Emergency Medicine
Center for treatment.
3.
Keep a copy of the Referral Slip for the department’s records.
4.
Immediately FAX a copy of the completed form to
the WC FAX line x 40535.
5. Notify Healthcare HR Workers’ Comp x 40522 or via email to
Cynthia Vazquez as soon as you are aware that an employee
has been taken off work.
7
Employee’s Referral Slip For Industrial
Injury And Report Of Accident
SPECIAL CIRCUMSTANCE #1: PRE-DESIGNATED DOCTOR
If the employee reports he/she has pre-designated MD –
•
•
Advise the employee to obtain medical care with the pre-designated MD as soon as
possible. He/She may go to Occupational Health or the Emergency Medicine Center
for immediate treatment, if the employee desires. Pre-designation of a private MD
does not bar the employee from getting treatment at OHF or the EMC.
Give and complete the WC Claim Form, Referral Slip. Provide When an Injury
Occurs brochure and WC Checklist per previous instruction.
SPECIAL CIRCUMSTANCE #2: : EMPLOYEE HAS BEEN
RECEIVING OUTSIDE TREATMENT
If the employee reports that he/she is being treated by a private MD –
•
•
•
Give and complete the WC Claim Form, Referral Slip. Provide When an Injury
Occurs brochure and WC Checklist per previous instruction.
Send the employee to Occupational Health with any medical records/MD notes they
have been given.
Advise the employee to contact Octagon Risk Services and give ORS the physician’s
8
information.
Workers’ Compensation Process
Octagon Risk Services reviews the claim and determines what
benefits the employee should receive. ORS notifies the employee
by mail and by phone whether claim is accepted, delayed, or
denied.
If the injury is delayed or denied, employee should file for
disability benefits. Contact the employee’s supervisor or dept
personnel rep to begin leave notification process. HR WC will
direct inquiries to the department per the Benefits leave process.
If the injury is approved as work related and the
employee receives a temporary disability check from
ORS, HR WC will immediately notify the department.
HR WC mails out Options letter to the employee.
Department receives a copy.
9
Workers’ Compensation Process
(Cont’d)
Workers’ Compensation payments for Temporary Disability or
Vocational Rehabilitation will effect the employee’s pay.
The employee must use his/her sick leave for first three
calendar days of the leave.
Follow the PTR instructions outlined in the next pages to pay
the employee appropriately.
The employee needs to immediately choose how he/she would like
us to treat his/her pay and notify Cynthia Vazquez in Human
Resources, and the department:
Option 1 -- Employee elects to receive only the workers’
comp payments.
Option 2-- Employee elects to use sick leave only to
supplement the workers’ comp payment.
Option 3-- Employee elects to use sick leave and vacation time
to supplement the workers’ comp payment.
10
OPTION 1
Employee elects to receive only the workers’
comp temporary disability payments.
Revise the LOA Notification as Approved WC Option 1
and email to Human Resources Benefits Team and
update the leave in EDB.
Immediately place the employee, if eligible,
on FMLA leave without pay.
If not eligible for FMLA, place the employee on
Workers’ Comp Leave Without Pay.
Use 09 for Workers’ Comp Code & clarify action on comments.
Do not report any time on WPS or EPRs.
Employee should receive no pay from payroll while
receiving temporary disability.
11
OPTION 1 (Cont’d)
Employee is fully responsible for Benefits contribution
according to the FMLA guidelines.
Employee must make employee contribution for health.
HR Benefits will notify the employee directly regarding all
benefits which are not paid for by FMLA.
Employee will also need to pay directly for health, dental, and
vision once the 12 weeks of FMLA exhaust.
Review the IDER and timesheet to determine
if there was any payment of sick leave/vacation time.
Sick leave and vacation paid are considered “overpayment”.
Enter a reduction transaction “RX” for the overpayment amount.
When the employee repays the amount, the sick leave and
vacation hours will be returned to balance by Hospital
Payroll.
12
OPTION 2
Employee elects to use sick leave only to supplement
the temporary disability payment.
Employee uses only a few hours SICK LEAVE each pay period to
supplement temporary disability to equal 100% of his/her regular
salary.
You will need to know:
1. The employee’s SICK LEAVE balance as of the date of
injury/date when employee first began losing time. Refer to
Accrual slips/Hospital Payroll/Timesheet.
2. The regular hours the employee would have worked for the dates
listed on the WC worksheet. Dates are inclusive.
3. Any pay that the employee may have already received for the
dates listed on the WC worksheet. Refer to the IDER screen.
13
OPTION 2 (Cont’d)
Complete the Option 2 worksheet sent by HR WC.
IF the Balance is enough to cover the “Difference” then the
employee remains at 100% pay for the WC Worksheet period.
Forward a completed copy of the worksheet via email to the
Hospital Payroll representative for your department.
Hospital Payroll will update the sick leave balance and award full
accruals to the employee. Sick leave may be used as accrued while
@ 100% salary.
Enter the transactions on PTR per the PTR Manual and
Payroll instruction.
Per University Policy, employee should receive shift
differentials in addition to base pay.
Use DOS code REG for base pay.
Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.
Use DOS code WCR for WC check deduction.
14
14
PROCESS BY PAY COMPUTE DEADLINES!
OPTION 2 (Cont’d)
Revise the LOA Notification as Approved WC Option 2
and email to Human Resources Benefits Team and
update the leave in EDB.
Place employee, if eligible, on FMLA Leave With Pay.
If not eligible for FMLA, place the employee on
Workers’ Comp Leave With Pay.
Use 09 for Workers’ Comp Code & clarify action on comments
Once the employee’s own sick leave exhausts, the
employee is eligible to receive 80% Extended Sick Leave
benefit.
Reduce employee time on EDB to 80%.
Do not report any time on WPS or EPR’s
Department will process the pay on PTR
15
OPTION 3
Employee elects to use sick leave and vacation to
supplement the temporary disability payment.
Employee uses only a few hours SICK LEAVE and VACATION
each pay period to supplement temporary disability to equal 100%
of his/her regular salary. Exhaust sick leave first, then vacation.
You will need to know:
1. The employee’s SICK LEAVE and VACATION balance as of
the date of injury/date when employee first began losing
time. Refer to Accrual slips/Hospital Payroll/Timesheet.
2. The regular hours the employee would have worked for the dates
listed on the WC worksheet. Dates are inclusive.
3. Any pay that the employee may have already received for the
dates listed on the WC worksheet. Refer to the IDER screen.
16
OPTION 3 (Cont’d)
Complete the Option 3 worksheet sent by HR WC.
IF the Balance is enough to cover the “Difference” then the
employee remains at 100% pay for the WC Worksheet period.
Forward a completed copy of the worksheet via email to Hospital
Payroll.
Hospital Payroll will update the sick leave/ vacation balance and
award full accruals to the employee. Sick leave and vacation may
be used as accrued while @ 100% salary.
Enter the transactions on PTR per the PTR Manual and
Payroll instruction.
Per University Policy, employee should receive shift
differentials in addition to base pay.
Use DOS code REG for base pay.
Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.
Use DOS code WCR for WC check deduction.
17
17
PROCESS BY PAY COMPUTE DEADLINES!
OPTION 3 (Cont’d)
Revise the LOA Notification as Approved WC Option 3
and email to Human Resources Benefits Team and
update the leave in EDB.
Place employee, if eligible, on FMLA Leave With Pay.
If not eligible for FMLA, place the employee on
Workers’ Comp Leave With Pay.
Use 09 for Workers’ Comp Code & clarify action on comments
Once the employee’s own sick leave and vacation
exhausts, the employee is eligible to receive 80%
Extended Sick Leave benefit.
Reduce employee time on EDB to 80%.
Do not report any time on WPS or EPRs
Department will process the pay on PTR
18
80% Extended Sick Leave
Employee elected Option 2 or 3 and accrual bank has
exhausted.
When an employee elects Options 2 or 3, the employee
is eligible for this benefit once the SL or SL/VA in the
employee’s bank is exhausted.
Department pays the employee the difference between [80% of
regular salary based on appt] and the [WC temporary disability
payment.]
80% ESL does not come out of employee’s individual bank.
Benefit is paid for 26 weeks from the date employee exhausted
his/her own SL or SL/VAC time on the WC worksheet and
continues to receive WC temporary disability.
Employee continues to accrue SL/VAC @ 100 % but cannot
use accruals until return to work or separation.
19
80% Extended Sick Leave (Cont’d)
Calculate 80% of the employee’s regular hours based on
appt for the dates listed on the 80% ESL Worksheet sent by
HR WC. Dates are inclusive.
Forward a completed copy of the worksheet via email to Hospital
Payroll.
Hospital Payroll will update the sick leave/ vacation balance and
award full accruals to the employee upon return to work or
separation.
Enter the transactions on PTR per the PTR Manual and
Payroll instruction.
Per University Policy, employee should receive shift
differentials in addition to base pay.
Use DOS code ESL for base pay.
Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.
Use DOS code WCR for WC check deduction.
20
PROCESS BY PAY COMPUTE DEADLINES!
80% Extended Sick Leave (Cont’d)
Confirm the LOA Notification to Human Resources
Benefits Team and confirm the leave is current.
Place employee, if eligible, on FMLA Leave With Pay.
If not eligible for FMLA, place the employee on
Workers’ Comp Leave With Pay.
Use 09 for Workers’ Comp Code & clarify action on comments
Reduce employee time on EDB to 80%.
Begin and end date of 80% reduction in time can be found on
80% ESL worksheet.
Do not report any time on WPS or EPRs
Department will process the pay on PTR
21
AFTER 80% ESL
HR WC will notify the department rep to update the
LOA Notification for the Human Resources Benefits
Team and update the leave in EDB.
Email the LOA Notification promptly so HR Benefits
can mail a disability packet to the employee.
Place the employee on Workers’ Comp Leave Without Pay.
Use 09 for Workers’ Comp Code & clarify action on comments
Correct employee time on EDB from 80% to original
appt.
Do not report any time on WPS or EPR’s
NOTIFY the HR Benefits Team via email on the
Return to Work Notice form if the employee returns
to work or pay status
22
AFTER 80% ESL (Cont’d)
Health Insurance coverage may continue -UC Regents will continue to pay the employee’s full health
benefits (Employee and University contribution) via the Health
Contingency Fund while the employee continues to receive
temporary disability payments AND has not been separated
from UCLA Medical Center.
Employee must make payment for all other insurances
and Benefits that he/she wishes to keep current
HR Benefits will coordinate direct payment of premiums for
all other benefits with employee.
23
General guidelines . . .
TIMESHEETS (EPRs/WPS)
WAITING PERIOD -Fill out the WPS/EPR with first 3 calendar days of sick leave.
If the employee does not have enough sick leave to cover the first 3 days, the
employee is entitled to receive 80% of his/her regular salary. Notify Human
Resources, Cynthia Vazquez, if the employee does not have enough sick leave.
Record no sick leave/vacation on timesheet after waiting period.
TO AVOID OVERPAYMENTS ONLY RECORD WAITING PERIOD
AS SL:
Individual situations may be considered. Advise employees about potential
overpayments if the employee requests sick leave/vacation pay while waiting
for the WC paycheck.
UPDATE the LOA NOTIFICATION form as needed.
UPDATE the leave in EDB.
24
What else should you do?
FMLA
Provide the employee with a FMLA packet.
All workers’ compensation leaves are FMLA leaves if leave is more than 3 days.
TIMELINESS
Complete the worksheets and process in EDB and PTR as they are provided to you.
If they are not processed, the employee does not receive pay, and benefits may be
discontinued.
HOLIDAYS
Employees should receive FULL holiday pay while at 100% or 80% pay. Do not
include holidays when calculating the hours worked for the worksheets.
PTO
If the employee on workers’ comp is eligible for PTO, immediately notify Enterprise
Payroll. Send notification by e-mail to the department’s payroll representative and
copy Lillian Wilson, Hospital Payroll.
While on Workers’ Comp, the PTO rules no longer apply and the employee’s
25
accrual bank reverts back to vacation and sick time.
25
New Employee Pamphlet/
Pre-designation of Physician
NEW EMPLOYEE PAMPHLET
 For employees hired on or after 01/01/03
New employees must be given written notice of workers’ compensation
rights
Includes a tear-off form to pre-designate their personal physician to treat
them in the event of a work-related injury.
Written notice must be provided to an employee no later than the end of his
first pay period.
Pamphlet with approved language available in Healthcare HR.
PRE-DESIGNATION OF PHYSICIAN
 Current form is available on the HR website
 Current employees may utilize that form – only new employees must receive

the whole pamphlet including the tear off form.
Employee must designate PRIOR TO AN INJURY the name and address of
the MD or DO in writing. The doctor must be someone who had treated the
employee before and who has the employee’s medical records.
26
PRE-DESIGNATION OF
PHYSICIAN
IF employee chooses to complete the form,
HE/SHE must return the form to Human Resources as soon as
he/she fills it out.
HR will clock in date of receipt.
HR must add the information to our database.
HR will return the original form to the department to be retained
in the employee’s personnel file.
If department receives form from the employee,
Clock in date of receipt.
Forward copy of the form to HR immediately.
Retain the original form in the employee’s personnel file.
HR must add the information to our database.
27
Types of Injuries
Types of Injuries
Indemnity
– Examples: Repetitive motion, fracture, or sprain
– Claims with lost time more than 3 days or anticipated permanent
disability
– Temporary disability, permanent disability, vocational rehabilitation,
partial replacement of lost wages
Medical
– Claims with lost time of 3 days or less
– May receive medical care and follow-up by Occupational Health or
Workers’ Compensation medical provider
First Aid
– No medical treatment needed
28
Types of compensation
•
Medical coverage
– Medical examinations, therapy, co-pays, prescriptions, mileage, equipment,
vocational rehabilitation
•
Temporary disability
– Represents 2/3 of the employee’s regular salary, up to the current maximum of
$602.00 per week for injuries occurring on or after 01/01/03.
– Starts with the fourth calendar day the employee is unable to work. The threeday waiting period is waived if the employee is hospitalized or disabled for 14
days or more
– Can also be WAGE LOSS which represents 2/3 of the employee’s lost earnings
from the total average weekly earnings, up to maximum, when return to work
on a part-time/modified basis
• Vocational Rehabilitation
– Training when employee’s injury prevents return to usual and customary job
•
Permanent disability
– Long-term effects on ability to work are calculated, or “rated”, taking into
account the body part affected, the occupation, the age and rate of pay at the
time of the injury/illness.
29
Assistance Directory
OCTAGON RISK SERVICES
10880 Wilshire Blvd, Suite 850
Los Angeles, CA 90024-6914
Mail code 691448
Phone
310 794 8247
Fax
310 794 8268
UCLA HEALTHCARE HUMAN
RESOURCES
10920 Wilshire Blvd, Suite 400
MC 167648
Phone
310 794 0500
Fax
310 794 0530
OCCUPATIONAL HEALTH FACILITY(OHF)
200 UCLA Medical Plaza, Suite 224
Monday through Friday
7:30 a.m. to 4:30 p.m.
Mail Code 172524
Phone
310 825 6771
Fax 310 206 4585
EMERGENCY MEDICINE CENTER (EMC)
BE-144 CHS Center for Health Sciences
Open 24 hours a day
Phone
310 825 2111
Fax 310 794 0599
CAMPUS PAYROLL
UCLA Wilshire Center, Suite 620
MC 141648
Phone
310 794 8706
Fax
310 794 8751
ENTERPRISE PAYROLL
UCLA Wilshire Center, Suite 1700
MC 167646
Phone
310 794 0127
Fax
310 794 8049
30
INFORMATION
INJURY REPORTING
CLAIM STATUS
PROGRAM INFORMATION
INJURY ANALYSIS/TRENDS
SUPPLEMENTAL PAYROLL
WORKSHEETS
INJURY INVESTIGATION ASSISTANCE
Cynthia Vazquez
Med Center Human Resources
x 40522
DISABILITY MANAGEMENT
RETURN TO WORK
VOCATIONAL REHABILITATION
LOSS CONTROL ASSISTANCE
Mark Briskie
Med Center Human Resources
x 40525
Claims Account Executive
Octagon Risk Services (ORS)
x 48247 phone
ACCIDENT PREVENTION
SAFETY INSPECTIONS/TRAINING
ACCIDENT INVESTIGATION
COORDINATION
ERGONOMIC EVALUATION
Victor Kennedy x 54012
200 Medical Plaza, Suite 202
692624
Daniel Phillips x 53389
Derick Nguyen x 45170
Building and Safety
MC 694116
31
• Review a Workers’ Compensation
Worksheet
• Calculate Sick Leave and Pay Adjustments
• Process a Leave of Absence in EDB
• Process Pay Adjustments and a Workers’
Compensation Check in PTR
32
SAMPLE # 1 (OPTION 2)
IMA EXAMPLE - OPTION 2
Title: Hospital __ Asst. I - 9252
Appointment: 100% (40 hr/wk, evening shift)
Salary: $13.50 hr/ + $.85 SDF
Injured: March 18, 2002
Sick Leave: 25.5 on date of injury
Note: Accrual date on March 30, 2002
ORS Check: $720.00 (March 19-Apr 1, 2002)
Returned to Work: April 2, 2002
33
WORKERS’ COMPENSATION INSTRUCTION SHEET
OPTION 2 – Sick Leave
REVISION
DATE:
04/03/02
EMPLOYEE:
IMA EXAMPLE
DEPARTMENT:
MODEL DEPARTMENT
DATE OF INJURY:
03/18/02
DATE
EMPLOYEE’S HOURLY RATE:
$13.50
EXTENSION:
52003
ORS CASE #:
200212345
EMPLOYEE ID:
987654321
DEPARTMENT REP:
POLLY PROCESSOR
NATURE OF INJURY:
STRAIN, LOW BACK
The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 720.00, for the
period 03/19/02 to and including 04/01/02.
The employee has elected OPTION 2 (use of all sick leave). This option entitles the employee to 100% of his/her earnings minus the
amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave benefit. The
employee continues to accrue sick leave and vacation benefits while disabled.
The department must take two separation actions items: 1) adjust the employee’s sick leave accruals and 2) adjust the employee’s pay.
The following must be done:
Adjust the employee’s sick leave:
a)
Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
sick leave accruals to the employee’s balance.
b)
Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
hours represented by the ORS check (53.3), which is calculated by dividing the ORS check by the employee’s hourly rate. The
“difference” represents the number of sick leave hours required to keep the employee at 100% pay status.

Sick leave hours available on 03/19/02 =
25.5
Accruals (if applicable) +

Total Normal Working Hours =
ADD in full
accruals of
SICK
LEAVE
while on
Option 2

72
Hours represented by ORS check = 53.3
Total Sick Leave Balance =
32.89
Difference from column #2 =
18.7
7.39
TOTAL Sick Leave balance =
Balance sick leave left for next worksheet
“DIFFERENCE” =
18.7
14.19
32.89
(deduct this “difference” from sick leave records) =
If the employee’s sick leave balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the
employee’s sick leave balance is enough to cover the “difference,” the employee will remain at 100% pay.
Adjust the employee’s pay:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave hours
used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave balances) Next, enter an “RX”
transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the
ORS check in the “Pay Period End Date” field.
This
balance is
left in
employee’s
bank.
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.
Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.
The department must notify the Workers’ Compensation Representative on the date the employee returns to work.
Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.
Distribution:
Department POLLY PROCESSR
Medical Center Payroll Office MED CTR PAYROLL REP 1
Campus Payroll Office GTAYLOR
34
S
M
MARCH 2002
T
W
T
3
10
17
24
31
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
F
1
8
15
22
29
S
2
9
16
23
30
WORKSHEET
S
7
14
21
28
SAMPLE 1
IMA EXAMPLE
100% BW
$13.50/hr
$.85 SDF
M
1
8
15
22
29
APRIL 2002
T
W
T
2
3
4
9
10
11
16
17
18
23
24 25
30
F
5
12
19
26
S
6
13
20
27
WORKER'S COMP PAYMENTS: (Refer to Worker's Comp. Instruction Sheet)
AMOUNT OPTION
For the period
3/19/02
through
4/1/02
$720.00
Option 2
SALARY PAYMENTS:(Refer to ROE or to the IDER/IERN screen)
HRS/%
DOS CODE
Payperiod:
3/30/02
32
REG
8 worked hours + 24 SL hours
Was paid on 04/10/02 payday
PAYMENT ANALYSIS: (Refer to BW Payroll Calendar)
HRS/%
DOS CODE
Payperiod:
3/30/02
8
REG
1 day worked, 03/18/02
8
REG
1 holiday @100%, 03/25/02
64
REG
8 days @ 100% pay,
03/19-03/22/02, 03/26-03/29/02
4/13/02
8
REG
1 day @100% pay, 04/01/02
PTR TRANSACTIONS:
TC
LX
LX
Inst. Sheet
TC
RX
PER. END DATE
3/30/02
4/13/02
PER. END DATE
04/01/02
TIME
48 hrs
8 hrs
RATE
$13.50
$13.50
DOS
REG
REG
RATE/Amt
$720.00
DOS
WCR
Note:
Any other payments such as NSD, SDF etc. due employee (refer to EDB
appointment) should also be calculated and paid based on the above.
35
IDER SCREEN
PPIDER0-I1214
Pay Cycle:
ID:
Hm Dept:
Check No:
Departmental Inquiry
04/15/02 13:50:17
Earnings Distributions
Userid: HPJRV
B2 Processed In: 03/30/02 Check Date: 04/10/02
xxxxxxxxx
Name: EXAMPLE, IMA
SSN: XXX-XX-XXXX
280300
MC-HUM RES
Disp: 8
Emplmt Status: A
Type: CUR-ACTIVITY
PAR Control No: 697
01 TC: AP FAU: 4-427705-63000-2
Rate:
13.5000 Time H: 32.00
Time %:
ERC: E
Typ: 2
TUC: EX SHC:
DUC:
02 TC: AP FAU: 4-427705Rate:
0.85000 Time H:
ERC:
Typ:
TUC:
TC:
Rate:
ERC:
Next Func:
Pay Cycle:
-63000-2
32.00
Time %:
SHC:
DUC:
FAU:
Time H:
TUC:
Typ:
ID:
Time %:
SHC:
DUC:
Name:
Check Date:
Title: 9252 Gross:
432.00
.0000 Period: 03/30/02-B- - -N
Cov: C Ret: 0
DOS: REG
Title: 9252 Gross:
6.80
Period: 03/30/02-B- - -N
Cov:
Ret:
DOS:
Title:
Gross:
Period:
Cov:
Ret:
DOS:
SSN:
Review IDER screen to verify if any hours have been paid
during the pay period for which the adjustments are being made. 36
9252 HOSP__ASST II
EXAMPLE, IMA
987654321
031702-
0330020.00
0.00
32.00
8.00
03/29/02
03/17/02
03/18/02
03/19/02
03/20/02
03/21/02
03/22/02
37
EXAMPLE, IMA
03/17/02
03/30/02
38
Logging on to OASIS for PTR
Log on to Oasis
Oasis Menu Screen will appear, enter PPP
Online Application
Main Menu
Go to Next Function field, enter EDAT, enter Employee ID#, then the Enter key/
Dept Adjustment Transaction menu will appear
Go to Next Function field:
Enter EDLR
Enter Employee ID#
Refer to “Schedule for Updating PPS ON-Line” and enter the Pay Cycle, I.e., B1 or B2 as
appropriate
Enter the Pay Period End Date for the pay day on which the transaction(s) will be
processed and then the Enter key
The (EDLR) Dept. Adj. Trans screen will appear
Process LX and RX transactions from the Worker’s Comp Instruction Sheet
LX: REG 80.00 hours or ESL , and all other data, I.e., Title Code, Full Account
Number, Rate, enter “H” in AH field
RX: WCR (worker’s comp payment) enter “A” in AH field
Go to F10 and enter comments, Go to F6 to add Payroll Notification and appropriate HR
Benefits Team members as carbon copy recipients of the ASAP notification, Go to F3 to
39
return to list of ASAP recipients, then F9 to Update transaction
Refer to PTR User Guide, Section E13, Special Processes for additional help
EDB - Leave of Absence
PPELVE0-E0875
17:03:11
10/23/01 22:18:37
ID: 987654321
Name:
EDB Entry/Update
Leave of Absence Data
example, ima
Leave of Absence Action Code
Leave of Absence Begin Date
:07
:031902
LOAB 11/08/01
OPTION 2
Userid: HPJRV
SSN: 987-65-4321
Leave of Absence Action Codes
07
08
Return:
Leave with Pay
Leave without Pay
040202 Type:16
Type of Leave of Absence
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
99
Sabbatical at full salary
Sabbatical at partial salary
Sabbatical in residence at full salary
Pregnancy Disability
Extended Illness
Government/Public Service
Professional Development
Personal
Worker’s compensation
Furlough
Military
Special Research
Administration
Sabbatical in Residence at partial Salary
Family and Medical Leave Without Pay
Family and Medical Leave With Pay
Other (as specified in Personnel File)
Leaves of absence due to a work incurred
injury run concurrent with Family &
Medical Leave.
The leave should first be processed as a
Family & Medical Leave, either with or
without pay as appropriate.
The comments on the ASAP notification
should state that the employee is on
worker’s comp and the time period.
Once the employee has exhausted the
Family & Medical Leave period and is still
on worker’s comp, the leave type would 40
then be 09 - Worker’s Comp.
S
M
MARCH 2002
T
W
T
3
10
17
24
31
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
F
1
8
15
22
29
S
2
9
16
23
30
PTR – Pay Adjustments
PPETLR-E1064
Dept. Adj Trans
11/08/01 19:45:38
11/05/01 23:40:13
Late/Reduce Pay (EDLR)
Userid: HPJRV
ID: 700486135 Name: EXAMPLE, IMA
SSN: 987-65-4321
Emp Status: A
Pay End: 04/13/02 Check Date: 04/24/02 Pay Cycle: B2
Page 1 of 1
C
Seq:
Tr:LX
Per End:033002 Pay Cy:B Dst:11 E: E T: D:
Ttl:9252
LACFPS: 4 427705 63000
DOS:REG
Time: 48.00
Seq:
Tr:LX
2
H%:
H
DOS:
Rate:13.5000
Hr:
DOS:
Per End:033002 Pay Cy:B Dst:12
LACFPS: 4 427705 63000
DOS: SDF
Time: 48.00
H%:
H
E:
Rate: .8500
DOS:
Hr:
T: D:
DOS:
Seq:
Tr: RX Per End:040102 Pay Cy:B Dst:
E: T: D:
LACFPS: 4 427705 63000 2
Rate: 00720.00
DOS: WCR
Time:
H%:
DOS:
Hr:
DOS:
AH: H
Hr:
WSP:
Ttl:9252
AH: H
Hr:
Ttl: 9252
AH: A
Hr:
WSP:
Payroll pay period
end date & hours
covered by worker’s
Comp check
WSP:
EDB preparer must take two (2) separate actions
OPTION 2
Worker’s comp check
amount & end date of
period covered
Injured: 3/18/02
ORS Check: 0319 040102
NEED TO ENTER
THE LX FOR PPE
04/1302 8 HOURS
ON NEXT PAGE
 adjust the employee’s sick leave accruals (Coordinate w/Hospital Payroll))
 adjust the employee’s pay
LX Transaction = Hours employee would have worked during the period covered by the Worker’s Comp check
RX Transaction = Credit for the Worker’s Comp check
41
WCR = DOS code used to report the amount of the Worker’s Comp check as a credit for the period of the check
Transaction Codes
and Notifications
Screen Label
Tr
Data Name
Transaction Type Code
Data Values/Comments
Code indicating the nature of the transaction
PTR Screen
EDLR
LX - Late Pay
Used to report the sick leave and/or 80% ESL to be paid
RX - Reduction in pay or leave
Used to report the ORS check as a by-agreement credit
Carbon Copy Recipients of ASAP:
Payroll Notification and HR Benefits Team
HR WC Cynthia Vazquez OPTIONAL
Comments on the ASAP notification:
EXAMPLES: “Employee on approved WC leave, Option 2 use of Sick Leave”
“Employee has filed WC claim pending Approval. Extended Illness.”
“Employee on 80% Extended Sick Leave under workers’ comp”
“Extend WC LWOP. 80%ESL exhausted 05/30/03.”
42
SAMPLE #1 (OPTION 2)
PPETLR-E1064
11/05/01 23:51:40
ID: 700486135
Dept. Adj Trans
Late/Reduce Pay (EDLR)
NAME:
Pay End: 041302
Seq: Tr: LX
LACFPS:
Check Date: 042402
Per End: 033002
4 427980 63000
DOS: REG
Time:
Seq:
Tr: LX
LACFPS:
48.00
4 427980 63000
DOS: SDF
Time: 48.00
Tr: RX
Seq:
LACFPS:
EXAMPLE, IMA
4 427980 63000
DOS: WCR
Time:
Payroll pay period end
date & hours covered
by worker’s comp
Check
11/08/01 08:45:02
Userid: MFLWO
SSN: 987-65-4321
Emp Status: A
Pay Cycle: B2
Pay Cy: B
Dst: 11
E: E
T:
D:
Ttl: 9252
Rate: 13.5000
2
H%: H
Per End: 033002
DOS:
Hr:
Pay Cy: B Dst: 12
1 of 2
Page
AH: H
DOS:
E: E
T:
Hr:
D:
Ttl: 9252
Rate: .8500
2
H%: H
Per End: 040102
DOS:
Hr:
Pay Cy: B Dst:
AH: H
DOS:
E: E
T:
Rate: 00720.00
2
H%:
DOS:
Hr:
WSP:
Hr:
D:
WSP:
Ttl: 9252
AH: A
DOS:
Hr:
WSP:
Worker’s Comp check
amount and end date of
period covered
43
SAMPLE #1 (OPTION 2)
PPETLR-E1064
11/05/01 23:51:40
ID: 700486135
Dept. Adj Trans
Late/Reduce Pay (EDLR)
NAME:
Pay End: 041302
Seq:
LACFPS:
Tr: LX
4 427980 63000
Time:
Seq:
Tr: LX
DOS: SDF
Seq:
LACFPS:
DOS: Time:
SSN: 987-65-4321
Check Date: 042402
DOS: REG
LACFPS:
EXAMPLE, IMA
8.00
4 427980 63000
Time: 8.00
Tr:
H%:
E: E
T:
D:
DOS:
Per End: 041302
DOS:
E: E
T:
Hr:
D:
DOS:
Pay Cy:
Hr:
AH: H
Hr:
Dst:
Rate:
DOS:
WSP:
Ttl: 9252
Rate: .8500
2
of 2
AH: H
Hr:
Pay Cy: B Dst: 12
2
Ttl: 9252
Rate: 13.5000
H%: H
DOS:
Page
Pay Cy: B Dst: 11
2
Per End
Emp Status: A
Pay Cycle: B2
Per End: 041302
H%: H
11/08/01 08:45:02
Userid: MFLWO
DOS:
E:
Hr:
T:
Hr:
D:
WSP:
Ttl:
AH:
WSP:
Payroll pay period end
date & hours covered
by worker’s comp
Check
44
SAMPLE #2 (OPTION 3)
MISTER JONES - OPTION 3
Title: CN II (9139)
Appointment: 90% (36 hr/wk, night shift)
Salary: $29.51 hr/ + $4.00 NSD
Injured: February 1, 2001 @ 3a.m. (sent to ER, taken off work)
Sick Leave: 18 s/l and 24 v/l on date of injury
ORS Check: $980.00 (February 2-15, 2001)
$980.00 (February 16-March 1, 2001)
Returned to Work: March 2, 2001
45
WORKERS’ COMPENSATION INSTRUCTION SHEET
OPTION 3 – Sick Leave and Vacation
REVISION
DATE:
03/04/01
EMPLOYEE:
MISTER JONES
DEPARTMENT:
MODEL DEPARTMENT B
DATE OF INJURY:
02/01/01
EMPLOYEE ID:
123456789
DEPARTMENT REP:
INGRID INPUTTER
NATURE OF INJURY:
STRAIN, R ARM
DATE
EMPLOYEE’S HOURLY RATE:
29.51
EXTENSION:
98765
ORS CASE #:
200112345
The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 980.00, for the
period 02/02/01 to and including 02/15/01.
The employee has elected OPTION 3 (use of all sick leave and vacation). This option entitles the employee to 100% of his/her earnings
minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave
benefit. The employee continues to accrue sick leave and vacation benefits while disabled.
The department must take two separation actions items: 1) adjust the employee’s sick leave and vacation accruals and 2) adjust the
employee’s pay. The following must be done:
Adjust the employee’s sick leave:
a)
Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
sick leave and vacation accruals to the employee’s balance.
b)
Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
hours represented by the ORS check (33.2), which is calculated by dividing the ORS check by the employee’s hourly rate. The
“difference” represents the number of sick leave and vacation hours required to keep the employee at 100% pay status.



Sick Leave and Vacation hours available on Total Normal Working Hours =
72
Total Sick Leave and Vacation Balance =
02/01/01 = 18 + 24
56.96
Accruals (if applicable) = Hours represented by ORS check = 33.2
Difference from column #2 =
38.79
6.65 + 8.31
TOTAL Sick Leave and Vacation balance = “DIFFERENCE” =
38.79 Balance sick leave/vacation left for next
worksheet =
18.17
56.96 (deduct this “difference” from SL/VA records)
If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If
the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay.
Adjust the employee’s pay:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and
vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation
balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period.
Enter the actual last date of the ORS check in the “Pay Period End Date” field.
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.
Add in the
appropriate
accruals
based on
Option 2 or
3!!!
While at
100% pay,
add in 100%
accruals.
Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.
The department must notify the Workers’ Compensation Representative on the date the employee returns to work.
Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.
Distribution:
Department ingridi inputter
Medical Center Payroll Office med center payroll rep 2
Campus Payroll Office g taylor
46
WORKERS’ COMPENSATION INSTRUCTION SHEET
OPTION 3 – Sick Leave and Vacation
REVISION
DATE:
03/04/01
EMPLOYEE:
MISTER JONES
DEPARTMENT:
MODEL DEPARTMENT B
DATE OF INJURY:
02/01/01
EMPLOYEE ID:
123456789
DEPARTMENT REP:
INGRID INPUTTER
NATURE OF INJURY:
STRAIN, R ARM
DATE
EMPLOYEE’S HOURLY RATE:
29.51
EXTENSION:
98765
ORS CASE #:
200112345
The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 980.00, for the
period 02/16/01 to and including 03/01/01.
The employee has elected OPTION 3 (use of all sick leave and vacation). This option entitles the employee to 100% of his/her earnings
minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave
benefit. The employee continues to accrue sick leave and vacation benefits while disabled.
The department must take two separation actions items: 1) adjust the employee’s sick leave and vacation accruals and 2) adjust the
employee’s pay. The following must be done:
Adjust the employee’s sick leave:
a)
Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
sick leave and vacation accruals to the employee’s balance.
b)
Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
hours represented by the ORS check (33.2), which is calculated by dividing the ORS check by the employee’s hourly rate. The
“difference” represents the number of sick leave and vacation hours required to keep the employee at 100% pay status.



Sick Leave and Vacation hours available on Total Normal Working Hours =
64.8
Total Sick Leave and Vacation Balance =
02/01/01 = 18.17
18.17
Accruals (if applicable) = Hours represented by ORS check = 33.2
Difference from column #2 =
31.6
NONE
TOTAL Sick Leave and Vacation balance = “DIFFERENCE” =
Balance sick leave/vacation left for next
31.6
18.17 (deduct this “difference” from SL/VA records)
worksheet =

If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If
the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay.
Adjust the employee’s pay:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and
vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation
balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period.
Enter the actual last date of the ORS check in the “Pay Period End Date” field.
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.
Not enough
SL/VAC to
complete
worksheet!
Contact
Healthcare
HR to
change to
80%ESL.
Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.
The department must notify the Workers’ Compensation Representative on the date the employee returns to work.
Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.
Distribution:
Department
Medical Center Payroll Office
Campus Payroll Office
47
WORKERS’ COMPENSATION INSTRUCTION SHEET
OPTION 3 – Sick Leave and Vacation
REVISION X DATE 03/06/01
DATE:
03/04/01
EMPLOYEE:
MISTER JONES
DEPARTMENT:
MODEL DEPARTMENT B
DATE OF INJURY:
02/01/01
EMPLOYEE ID:
123456789
DEPARTMENT REP:
INGRID INPUTTER
NATURE OF INJURY:
STRAIN, R ARM
EMPLOYEE’S HOURLY RATE:
29.51
EXTENSION:
98765
ORS CASE #:
200112345
The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 490.00, for the
period 02/16/01 to and including 02/22/01.
NOTE
REVISION
DATE
The employee has elected OPTION 3 (use of all sick leave and vacation). This option entitles the employee to 100% of his/her earnings
minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave
benefit. The employee continues to accrue sick leave and vacation benefits while disabled.
The department must take two separation actions items: 1) adjust the employee’s sick leave and vacation accruals and 2) adjust the
employee’s pay. The following must be done:
Adjust the employee’s sick leave:
a)
Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
sick leave and vacation accruals to the employee’s balance.
b)
Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
hours represented by the ORS check (16.6), which is calculated by dividing the ORS check by the employee’s hourly rate. The
“difference” represents the number of sick leave and vacation hours required to keep the employee at 100% pay status.



Sick Leave and Vacation hours available on Total Normal Working Hours =
28.8
Total Sick Leave and Vacation Balance =
02/01/01 = 18.17
18.17
Accruals (if applicable) = Hours represented by ORS check = 16.6
Difference from column #2 =
12.2
NONE
TOTAL Sick Leave and Vacation balance = “DIFFERENCE” =
Balance sick leave/vacation left for next
12.2
18.17 (deduct this “difference” from SL/VA records)
worksheet =
5.97
If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If
the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay.
Adjust the employee’s pay:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and
vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation
balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period.
Enter the actual last date of the ORS check in the “Pay Period End Date” field.
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.
This balance
is left in
employee’s
bank.
Accruals
while on
80%ESL will
be added to
this
balance.
Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.
The department must notify the Workers’ Compensation Representative on the date the employee returns to work.
Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.
Distribution:
Department
INGRID INPUTTER
Medical Center Payroll Office MED CTR REP 2
Campus Payroll Office G TAYLOR
48
WORKERS’ COMPENSATION INSTRUCTION SHEET
80% Extended Sick Leave Benefit
REVISION X DATE 03/04/01
DATE:
03/04/01
EMPLOYEE:
EMPLOYEE ID:
EMPLOYEE’S HOURLY RATE:
MISTER JONES
123456789
29.51
DEPARTMENT:
DEPARTMENT REP:
EXTENSION:
MODEL DEPARTMENT B
INGRID INPUTTER
98765
DATE OF INJURY:
NATURE OF INJURY:
ORS CASE #:
02/01/01
STRAIN, R ARM
200112345
80% Extended Sick Leave Benefit is automatic if the employee has selected Options 2 or 3 and has exhausted sick leave and/or
vacation, depending on which option was selected.
The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 490.00, for
the period 02/23/01 to and including 03/01/01.
This employee, who previously selected OPTION 2
OPTION 3 X, has exhausted all sick leave (and vacation, if applicable), and is
now eligible for the 80% Extended Sick Leave Benefit. The employee should remain on the 80% Extended Sick Leave basis from
02/23/01 through 08/22/01, or until he/she is released to return to work, which occurs first.
The department must adjust the employee’s pay as follows:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
If the EDB has not been updated with the 80% distribution in time to pay a positive time employee from the Roster, use the
Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “ESL” DOS code to report 80% of the actual
number of hours the employee would have worked. Next, enter an “RX” transaction, using the “WCR” DOS code to report the
amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date”
field.
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the
comments that the transaction is for a worker’s compensation adjustment – 80%ESL. The Payroll Office will match the transaction to
their copy of the Instruction Sheet.
Vacation and Sick Leave Accruals
Employees should receive FULL accruals for the time they were receiving less than full pay while they were out on workers’
compensation, including the time they were entitled to 80% Extended Sick Leave benefits. Adjustments should be made to vacation
and sick leave accruals after the employee returns to work. Notify your Medical Center Payroll Representative and coordinate
adjustment.
BEGIN and
END dates
of the
80% ESL
benefit.
Holiday Hours
Employee should receive FULL pay for holidays while receiving the 80% Extended Sick Leave benefit. Employee will accrue the full
holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University.
The department must notify the Workers’ Compensation Representative on the date the employee returns to work.
Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll
Office at extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’
Compensation Representative at extension 40500.
Distribution:
Department INGRID INPUTTER
Medical Center Payroll Office MED CENTER PAYROLL REP 2
Campus Payroll Office G TAYLOR
49
EDB Transaction for Employee on
80% Extended Sick Leave
Page 1 of 2
PPEAPP0-E1287
EDB Entry/Update
11/13/01 18:25:38
11/05/01 23:40:13
Appointments/Distributions
Userid: HPJRV
ID: 123456789 Name: JONES, MISTER
SSN: XXX-XX-XXXX Pri Pay: BW
PAF Gen No:
48
Pg 01 of 02
Appt
Actions Pgm Typ Bas Pd Ovr
Appt Begin Appt End Dur Dept FLSA
40
1
2
091597
999999
I 280300 0
Title
Grade %Full F/V Ann/Hr Rate Rt Sch Time Lv
9139 CLINICAL NURSE II
0.90
F
29.5100
H BW
N
N
Dist Actions L Acct
CC
Fund PC
S
FTE Dis %
42
4 427705
63000
2 MEDCTR-HUMAN RESOURCES
0.9000
Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC WSP
093001
022201
29.5100
REG
Dist Actions L Acct
CC
Fund PC
S
Dis %
41
16
4 427705
63000 2 MEDCTR-HUMAN RESOURCES
Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC
022301
082201
29.5100
ESL
FTE
0.8000
WSP
ESL = DOS code for the 80% Extended Sick Leave period
50
EDB Transaction for Employee on
80% Extended Sick Leave (Cont’d)
Page 2 of 2
PPEAPP0-E1287
EDB Entry/Update
11/13/01 18:25:38
11/05/01 23:40:13
Appointments/Distributions
Userid: HPJRV
ID: 123456789 Name: JONES, MISTER
SSN: XXX-XX-XXXX Pri Pay: BW
PAF Gen No:
48
Pg 02 of 02
Appt
Actions Pgm Typ Bas Pd Ovr ppt Begin Appt End Dur ept
FLSA
40
1
2
091597
999999
I 280300 0
Title
Grade %Full F/V Ann/Hr Rate Rt Sch Time Lv
9139 CLINICAL NURSE II
0.90
F
29.5100
H BW
N
N
Dist
43
Actions L Acct
CC
Fund PC
S
FTE
4 427705
63000 2 MEDCTR-HUMAN RESOURCES
Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC
082301
999999
29.5100
REG
Dis %
0.9000
WSP
Dist
Actions L Acct
FTE
Dis %
DUC
WSP
Pay Begin
CC
Pay End
Fund PC
Step
O/A
S
Rate/Amount
DOS
PRQ
Comments on the ASAP notification: “Employee on 80% extended
sick leave under workers’ comp”
Carbon Copy Recipients of ASAP: Payroll Notification and HR
Benefits Team
51
SAMPLE #2 (OPTION 3)
PPETLR-E1064
08:45:02
11/05/01 23:51:40
Dept. Adj Trans
Late/Reduce Pay (EDLR)
NAME: JONES, MISTER
ID: 000345789
Pay End: 020301
Seq:
LACFPS:
Check Date: 11/21/01
Tr: LX
Per End: 020301
4 427980 63000
DOS: REG Time: 7.20
Seq:
Tr: LX
LACFPS:
4 427980 63000
DOS: NSD
Seq:
LACFPS:
Tr: RX
DOS:
Per End: 021501
Pay Cy: B
Page
Dst: 11
E: E
T:
Hr:
Pay Cy: B
DOS:
Dst: 12
DOS:
Hr:
D:
Ttl: 9139
Hr:
E: E
WSP:
T:
D:
Ttl: 9139
AH: H
Hr:
Pay Cy: B
1 of 4
AH: H
DOS:
Hr:
E: E
Dst:
Rate: 980.00
2
H%:
Pay Cycle: B2
Rate: 4.0000
2
H%: H
4 427980 63000
DOS: WCR Time:
WSP:
DOS:
Per End: 020301
Time: 7.20
Userid: MFLWO
SSN: 239-00-2367
Emp Status: A
Rate: 29.5100
2
H%: H
11/08/01
WSP:
T:
D:
Ttl: 9139
AH: A
DOS:
Hr:
52
SAMPLE #2 (OPTION 3)
PPETLR-E1064
11/05/01 23:51:40
Dept. Adj Trans
Late/Reduce Pay (EDLR)
NAME: JONES, MISTER
ID: 000345789
Pay End: 021701
Seq:
LACFPS:
Check Date: 11/21/01
Tr: LX
Per End: 021701
4 427980 63000
DOS: REG Time: 72.00
Seq:
LACFPS:
DOS: NSD
Seq:
LACFPS:
Tr: LX
Time: 72.00
Tr: RX
DOS:
Per End: 030101
Page 2 of
Pay Cycle: B2
Pay Cy: B
E: E
Dst:
T:
Hr:
Pay Cy: B
DOS:
Hr:
E: E
Dst:
Hr:
Pay Cy: B
DOS:
Hr:
D:
4
Ttl: 9139
AH: H
WSP:
T:
D:
Ttl: 9139
AH: H
DOS:
Hr:
E: E
Dst:
Rate: 490.00
2
H%:
Emp Status: A
Rate: 04.0000
2
H%: H
4 427980 63000
DOS: WCR Time:
DOS:
Per End: 021701
4 427980 63000
SSN: 239-00-2367
Rate: 29.5100
2
H%: H
11/08/01 08:45:02
Userid: MFLWO
WSP:
T:
D:
Ttl: 9139
AH: A
DOS:
Hr:
WSP:
53
SAMPLE #2 (OPTION 3)
PPETLR-E1064
Dept. Adj Trans
11/08/01 08:45:02
11/05/01 23:51:40
Late/Reduce Pay (EDLR)
Userid: MFLWO
ID: 000345789
NAME: JONES, MISTER
SSN: 239-00-2367
Emp Status: A
Pay End: 030301
Seq:
LACFPS:
Check Date: 11/21/01
Tr: LX
Per End: 030301
4 427980 63000
DOS: REG Time: 7.20
Seq:
LACFPS:
DOS: NSD
Seq:
LACFPS:
Tr: LX
Time: 7.20
Tr: RX
DOS:
Per End: 022201
T:
Hr:
Pay Cy: B
D:
DOS:
Hr:
E: E
Dst:
Hr:
Pay Cy: B
DOS:
Hr:
3 of 4
Ttl: 9139
AH: H
WSP:
T:
D:
Ttl: 9139
AH: H
DOS:
Hr:
E: E
Dst:
Rate: 490.00
2
H%:
E: E
Dst:
Rate: 04.0000
2
H%: H
4 427980 63000
DOS: WCR Time:
DOS:
Per End: 030301
4 427980 63000
Pay Cy: B
Page
Rate: 29.5100
2
H%: H
Pay Cycle: B2
WSP:
T:
D:
Ttl: 9139
AH: A
DOS:
Hr:
WSP:
54
SAMPLE #2 (OPTION 3)
PPETLR-E1064
11/05/01 23:51:40
Dept. Adj Trans
Late/Reduce Pay (EDLR)
NAME: JONES, MISTER
ID: 000345789
Pay End: 030301
Seq:
LACFPS:
Check Date: 11/21/01
Tr: LX
Per End: 030301
4 427980 63000
DOS: REG Time: 21.60
Seq:
LACFPS:
DOS: NSD
Seq:
LACFPS:
DOS: ESL
Tr: LX
Time: 21.60
Tr: LX
DOS:
Per End 030301
Pay Cycle: B2
Pay Cy: B
Page
E: E
Dst:
T:
Pay Cy: B
D:
DOS:
Hr:
E: E
Dst:
Hr:
Hr:
Ttl: 9139
WSP:
T:
D:
Ttl: 9139
AH: H
DOS:
Hr:
E: E
Dst:
Rate: 29.5100
DOS:
4 of 4
AH: H
Hr:
Pay Cy: B
2
H%: H
Emp Status: A
Rate: 04.0000
2
H%: H
4 427980 63000
Time: 28.80
DOS:
Per End: 030301
4 427980 63000
SSN: 239-00-2367
Rate: 29.5100
2
H%: H
11/08/01 08:45:02
Userid: MFLWO
WSP:
T:
D:
Ttl: 9139
AH: H
DOS:
Hr:
WSP:
55
SAMPLE # 3 (Option 1)
HOURLY01, STUDENT - OPTION 1
Title: Admin Specialist (7646)
Appointment: 100% (5 days/week, day shift)
Salary: $19.25/hr
Injured: May 12, 2003 @ 9 a.m. (sent to OHF, taken off work)
Sick Leave: 110 s/l and 24 v/l on date of injury
ORS Check: $513.30 (May 12-18, 2003)
Returned to Work: May 19, 2003
56
57
IDER SCREEN
PPIDER0-I1214
Pay Cycle:
ID:
Hm Dept:
Check No:
Departmental Inquiry
05/30/03 13:50:17
Earnings Distributions
Userid: HPJRV
B2 Processed In: 05/24/03 Check Date: 06/04/03
xxxxxxxxx
Name: HOURLY01, STUDENT
SSN: XXX-XX-XXXX
280300
MC-HUM RES
Disp: 8
Emplmt Status: A
Type: CUR-ACTIVITY
PAR Control No: 697
01 TC: AP FAU: 4-427705-63000-2
Rate:
19.2500 Time H: 40.00
Time %:
ERC: E
Typ: 2
TUC: EX SHC:
DUC:
02 TC: AP FAU: 4-427705Rate:
Time H:
ERC:
Typ:
TUC:
SHC:
TC:
Rate:
ERC:
Time %:
SHC:
DUC:
Next Func:
Pay Cycle:
Time %:
DUC:
FAU:
Time H:
TUC:
Typ:
ID:
Name:
Check Date:
Title: 7646
Gross:
770.00
.0000 Period: 05/24/03-B- - -N
Cov: C Ret: 0
DOS: REG
Title: 7646 Gross:
Period: 03/30/02-B- - -N
Cov:
Ret:
DOS:
Title:
Gross:
Period:
Cov:
Ret:
DOS:
SSN:
Review IDER screen to verify if any hours have been paid
during the pay period for which the adjustments are being made. 58
SAMPLE #3 (OPTION 1)
PPETLR-E1064
Dept. Adj Trans
08:45:02
11/05/01 23:51:40
Late/Reduce Pay (EDLR)
ID: 700486135
NAME: HOURLY01,STUDENT
SSN: XXX-XX-XXXX
Pay End: 052403
Check Date: 061803
Pay Cycle: B2
Seq:
r: RX
Per End: 052403
LACFPS:
4 427980 63000
2
DOS: REG
Time: 40.00
H%: H
Seq:
LACFPS:
DOS:
Seq:
LACFPS:
DOS:
Tr:
Time:
Tr:
Time:
Per End:
H%:
Per End:
H%:
Pay Cy: BDst: 11
Rate: 19.2500
DOS:
Hr:
Pay Cy:
DOS:
Pay Cy:
DOS:
E: E
11/08/01
Userid: MFLWO
Emp Status: A
Page 1 of 1
T:
D:
DOS:
Dst:
Rate:
Hr:
E:
Dst:
Rate:
Hr:
E:
T:
D:
DOS:
T:
DOS:
Ttl: 7646
AH: H
Hr:
WSP:
Ttl:
AH:
Hr:
D:
WSP:
Ttl:
Hr:
AH:
WSP:
UNDER OPTION 1
Reverse SL hours
paid during same
period as Workers’
Comp check
59
SAMPLE # 4 (Wage Loss)
WORKER, WANDA – OPTION 2/80% ESL/WAGE LOSS
Title: ASST I (4724)
Appointment: 100% (5 days/week, day shift)
Salary: $13.60/hr
Injured: February 28, 2003
Saw OHF, given restrictions which department
can accommodate 20 hours/week
Sick Leave: 7.39 s/l and 0 v/l on date of injury
Returned to Work: March 3, 2003 for 20 hours/week
on modified duty
ORS Check: $181.33 wage loss check March 2-March 8, 2003
$181.33 wage loss check March 9-March 15, 2003
60
MARCH 2003
WORKSHEET
S
SAMPLE 4 (WAGE LOSS)
WANDA WORKER
100% BW
$13.60/hr
M
T
W
T
F
x
S
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
WORKER'S COMP PAYMENTS: (Refer to Worker's Comp. Instruction Sheet)
AMOUNT OPTION
For the period
3/2/03
through
3/8/03
$181.33 Option 2 WAGE LOSS
3/9/03
3/15/03
181.33 80 % ESL WAGE LOSS
SALARY PAYMENTS:(Refer to ROE or to the IDER/IERN screen)
HRS/%
DOS CODE
Payperiod:
3/15/03
20
REG
WORKED 4 HOURS/DAY
20
REG
WORKED 4 HOURS/DAY
PAYMENT ANALYSIS: (Refer to BW Payroll Calendar)
HRS/%
DOS CODE
Payperiod:
3/15/03
20
REG
5
20
REG
5
3/15/03
20
REG
5
16
ESL
5
days
days
days
days
PTR TRANSACTIONS:
TC
LX
LX
RATE
$13.60
$13.60
DOS
REG
ESL
RATE/Amt
$181.33
181.33
DOS
WCR
WCR
Inst. Sheet
TC
RX
RX
PER. END DATE
3/15/03
3/15/03
PER. END DATE
3/8/03
3/15/03
TIME
20
16
@4 hours/day worked
@ 4 hrs/day @100%
@ 4 hours/day worked
@ 4 hrs/day @ 80%
Note:
Any other payments such as NSD, SDF etc. due employee (refer to EDB
appointment) should also be calculated and paid based on the above.
61
WORKERS’ COMPENSATION INSTRUCTION SHEET
OPTION 2 – Sick Leave
REVISION
DATE:
WAGE LOSS:
03/10/03
YES
EMPLOYEE:
WANDA WORKER
DEPARTMENT:
MODEL DEPARTMENT 4
DATE OF INJURY:
02/21/03
EMPLOYEE ID:
XXXXXXXXX
DEPARTMENT REP:
ELMO ENTRY
NATURE OF INJURY:
SPRAIN
DATE
EMPLOYEE’S HOURLY RATE:
13.60
EXTENSION:
XXXXX
ORS CASE #:
XXXX55555
The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 181.33, for the
period 03/02/03 to and including 03/08/03.
The employee has elected OPTION 2 (use of all sick leave). This option entitles the employee to 100% of his/her earnings minus the
amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave benefit. The
employee continues to accrue sick leave and vacation benefits while disabled.
The department must take two separation actions items: 1) adjust the employee’s sick leave accruals and 2) adjust the employee’s pay.
The following must be done:
Adjust the employee’s sick leave:
a)
Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
sick leave accruals to the employee’s balance.
b)
Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
hours represented by the ORS check (13.3), which is calculated by dividing the ORS check by the employee’s hourly rate. The
“difference” represents the number of sick leave hours required to keep the employee at 100% pay status.


NOTE:
WORKSHEET
WILL
INDICATE
THIS IS WAGE
LOSS

Sick leave hours available on 02/22/03 =
Total Sick Leave Balance =
7.39
Total Normal Working Hours =
20
7.39
Accruals (if applicable) +
Hours represented by ORS check = 13.3
Difference from column #2 =
6.7
NONE
TOTAL Sick Leave balance =
Balance sick leave left for next worksheet
“DIFFERENCE” =
6.7
0.7
7.39
(deduct this “difference” from sick leave records) =
If the employee’s sick leave balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the
employee’s sick leave balance is enough to cover the “difference,” the employee will remain at 100% pay.
Adjust the employee’s pay:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave hours
used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave balances) Next, enter an “RX”
transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the
ORS check in the “Pay Period End Date” field.
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.
Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.
The department must notify the Workers’ Compensation Representative on the date the employee returns to work.
Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.
Distribution:
Department
ELMO ENTRY
Medical Center Payroll Office R POTTS
Campus Payroll Office R CRUZ
WAGE LOSS
Use only the
remaining hours
needed to reach
100%.
Worked hours will be
submitted
regularly
through
WPS
62
WORKERS’ COMPENSATION INSTRUCTION SHEET
80% Extended Sick Leave Benefit
REVISION
DATE:
WAGE LOSS:
03/10/03
YES
EMPLOYEE:
WANDA WORKER
DEPARTMENT:
MODEL DEPARTMENT 4
DATE OF INJURY:
02/21/03
EMPLOYEE ID:
XXXXX XXXX
DEPARTMENT REP:
ELMO ENTRY
NATURE OF INJURY:
SPRAIN
DATE
EMPLOYEE’S HOURLY RATE:
13.60
EXTENSION:
XXXXX
ORS CASE #:
XXXX55555
80% Extended Sick Leave Benefit is automatic if the employee has selected Options 2 or 3 and has exhausted sick leave and/or
vacation, depending on which option was selected.
The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 181.33, for
the period 03/09/03 to and including 03/15/03.
This employee, who previously selected OPTION 2 X OPTION 3
, has exhausted all sick leave (and vacation, if applicable), and is
now eligible for the 80% Extended Sick Leave Benefit. The employee should remain on the 80% Extended Sick Leave basis from
03/09/03 through 09/13/03, or until he/she is released to return to work, which occurs first.
The department must adjust the employee’s pay as follows:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
If the EDB has not been updated with the 80% distribution in time to pay a positive time employee from the Roster, use the
Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “ESL” DOS code to report 80% of the actual
number of hours the employee would have worked. Next, enter an “RX” transaction, using the “WCR” DOS code to report the
amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date”
field.
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the
comments that the transaction is for a worker’s compensation adjustment – 80%ESL. The Payroll Office will match the transaction to
their copy of the Instruction Sheet.
Vacation and Sick Leave Accruals
Employees should receive FULL accruals for the time they were receiving less than full pay while they were out on workers’
compensation, including the time they were entitled to 80% Extended Sick Leave benefits. Adjustments should be made to vacation
and sick leave accruals after the employee returns to work. Notify your Medical Center Payroll Representative and coordinate
adjustment.
Holiday Hours
Employee should receive FULL pay for holidays while receiving the 80% Extended Sick Leave benefit. Employee will accrue the full
holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University.
The department must notify the Workers’ Compensation Representative on the date the employee returns to work.
Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll
Office at extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’
Compensation Representative at extension 40500.
Distribution:
Department ELMO ENTRY
Medical Center Payroll Office
Campus Payroll Office
R POTTS
R CRUZ
63
SAMPLE #4 (WAGE LOSS)
PPETLR-E1064
Dept. Adj Trans
11/05/01 23:51:40
Late/Reduce Pay (EDLR)
ID: 700486135
NAME: WORKER, WANDA
SSN: XXX-XX-XXXX
Pay End: 031503
Check Date: 032603
Pay Cycle: B2
Seq:
r: LX
Per End: 031503
LACFPS:
4 427980 63000
2
DOS: REG
Time: 20.00
H%: H
Pay Cy: B Dst: 11
Rate: 13.6000
DOS:
Hr:
E: E
Seq:
Tr: LX
LACFPS: 4 427980 63000
DOS: ESL
Time: 16.00
Pay Cy: B Dst: 11
Rate: 13.6000
DOS:
Hr:
E:
Per End: 031503
2
H%: H
T:
D:
Ttl: 4726
AH: H
Hr:
WSP:
DOS:
Seq:
Tr: RX
Per End: 030803
Pay Cy: B Dst:
E:
LACFPS:
4 427980 63000
2
Rate: 181.33
DOS: WCR Time:
H%:
DOS:
Hr:
WC check
amount and end
date of period
covered
11/08/01 08:45:02
Userid: MFLWO
Emp Status: A
Page 1 of 2
E
T:
DOS:
E
D:
Hr:
T:
DOS:
Ttl: 4724
AH: H
WSP:
D:
Ttl: 4724
AH: A
Hr:
WSP:
UNDER WAGE LOSS
Only need to LX the remaining hours
needed to reach 100% or 80%
Worked hours will be submitted
regularly through WPS
64
SAMPLE #4 (WAGE LOSS)
PPETLR-E1064
Dept. Adj Trans
11/05/01 23:51:40
Late/Reduce Pay (EDLR)
ID: 700486135
NAME: WORKER, WANDA
SSN: XXX-XX-XXXX
Pay End: 031503
Check Date: 032603
Pay Cycle: B2
Seq:
Tr: RX
Per End: 031503
Pay Cy: B Dst:
E:
LACFPS:
4 427980 63000
2
Rate: 181.33
DOS: WCR Time:
H%:
DOS:
Hr:
Seq:
LACFPS:
DOS:
Seq:
LACFPS:
DOS:
Tr:
Time:
Tr:
Time:
Per End:
H%:
Per End:
H%:
Pay Cy:
DOS:
Pay Cy:
Rate:
DOS:
Dst:
Rate:
Hr:
Dst:
Hr:
E:
11/08/01 08:45:02
Userid: MFLWO
Emp Status: A
Page 1 of 2
E
T:
Ttl: 4724
AH: A
Hr:
DOS:
T:
DOS:
E:
D:
T:
AH:
DOS:
D:
Hr:
D:
WSP:
Ttl:
AH:
WSP:
Ttl:
Hr:
WSP:
65