5.1 Lost Productivity @ 25% productivity rate

25% of weekly salary : 

Number of weeks : 

Sub-Total: 

 5.2 Lost Productivity @ 50% productivity rate

50% of weekly salary :

Number of weeks : 

Sub-Total: 

 5.3 Lost Productivity @ 75% productivity rate

75% of weekly salary :

Number of weeks : 

Sub-Total: 

 5.4 Co-workers lost productivity

Average hourly salary rate: 

Number of hours: 

Number of co-workers: 

Sub-Total: 

 5.5 Lost department productivity

Average weekly salary rate: 

Number of hours: 

Number of employees: 

Sub-Total: 

 5.6 Impact on the completion of a critical project

Cost of non-completion or delivery of a critical project: 

Sub-Total: 

 5.7 Reduced productivity of a manager or director

Hourly salary rate: 

Number of hours: 

Sub-Total: 

Total: