LABOR STANDARDS INTERVIEW

CONTRACT NUMBER

EMPLOYEE INFORMATION

LAST NAME

FIRST NAME

MI

NAME OF PRIME CONTRACTOR

STREET ADDRESS

NAME OF EMPLOYER

CITY

STATE

ZIP CODE

SUPERVISOR'S NAME

LAST NAME

FIRST NAME

MI

WORK CLASSIFICATION

WAGE RATE

ACTION

CHECK BELOW

YES

NO

Do you work over 8 hours per day?

Do you work over 40 hours per week?

Are you paid at least time and a half for overtime hours?

Are you receiving any cash payments for fringe benefits required by the posted wage determination decision?

WHAT DEDUCTIONS OTHER THAN TAXES AND SOCIAL SECURITY ARE MADE FROM YOUR PAY?

HOW MANY HOURS DID YOU WORK ON YOUR LAST WORK DAY BEFORE THIS INTERVIEW?

TOOLS YOU USE

DATE OF LAST WORK DAY BEFORE INTERVIEW (YYMMDD)

DATE YOU BEGAN WORK ON THIS PROJECT (YYMMDD)

THE ABOVE IS CORRECT TO THE BEST OF MY KNOWLEDGE

EMPLOYEE'S SIGNATURE

DATE (YYMMDD)

INTERVIEWER

SIGNATURE

TYPED OR PRINTED NAME

DATE (YYMMDD)

INTERVIEWER'S COMMENTS

WORK EMPLOYEE WAS DOING WHEN INTERVIEWED

ACTION (If explanation is needed, use comments section)

YES

NO

IS EMPLOYEE PROPERLY CLASSIFIED AND PAID?

ARE WAGE RATES AND POSTERS DISPLAYED?

FOR USE BY PAYROLL CHECKER

IS ABOVE INFORMATION IN AGREEMENT WITH PAYROLL DATA?

YES                                     NO

COMMENTS

CHECKER

LAST NAME

FIRST NAME

MI

JOB TITLE

SIGNATURE

DATE (YYMMDD)

AUTHORIZED FOR LOCAL REPRODUCTION
Previous edition not usable

STANDARD FORM 1445 (REV. 12-96)
Prescribed by GSA - FAR (48 CFR) 53.222(g)