Unpaid Wage & Overtime Dispute Log (Free PDF)

Document hours worked, expected pay, and any shortfalls so you can share a clear record with a lawyer, labor agency, or small claims court.

Wage dispute log builder

Log hours worked, expected pay, and amounts actually paid so you can show underpayment in mediation, agency filings, or court.

Employee name

Employer name

Job title

Pay period description

Summary notes

Add each shift or paycheck with expected vs. actual pay.

Work date

Hours worked

Hourly rate (expected)

Amount paid

Employer notes

Discrepancy notes

Total hours worked: 0.00

Expected total pay: $0.00

Actual pay total: $0.00

Estimated shortfall: $0.00

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