Wage Theft Evidence Log PDF

Keep a dated record of unpaid wages, overtime, or deductions and export a PDF for a state labor agency, the DOL, or an attorney.

Employee details

Enter your work info and document each instance of unpaid wages below.

Employee name

Employer / company

Job title

Work location (city/state)

Type(s) of wage theft

Period covered

List each shift or paycheck with missing pay and any proof.

Date

Shift hours

Hours worked

Hours paid

Amount missing

Evidence

Notes

Agency / attorney notes

Your data stays in your browser until you download.

Processing stays in your browser. PDFs generate locally—no uploads or accounts.
Downloads use a secure PDF blob helper (no raw array buffers or workers required).
Review details before sending; nothing here is legal advice or a substitute for local forms.