DWSRF_1445_Labor_Standards_Interview_Form.pdf
PDF 1005 KB Posted
- Attached to
- 2026 ON-CALL SIDEWALK SPOT REPAIR PROGRAM
- Solicitation number
- 25/26-48
- Issued by
- Hartford County, Connecticut
About this file
This is a Standard Form 1445 Labor Standards Interview Form prescribed by the General Services Administration for use in compliance with federal labor standards requirements on government contracts. The form is designed to be used by the Town of Manchester, Connecticut in connection with the 2026 On-Call Sidewalk Spot Repair Program (Bid No. 25/26-48). The document serves as a template for conducting interviews with employees working on the project to verify compliance with prevailing wage and labor standards requirements. The form captures essential employee information including name, address, work classification, wage rate, and employment details such as the prime contractor and employer names. It includes a series of verification questions regarding work hours, overtime compensation, fringe benefits, and proper wage rate classification. The form requires documentation of the employee's work duties at the time of interview, verification that wage rates and posters are properly displayed, and confirmation that the employee is properly classified and paid according to applicable wage determinations.
The form functions as both an employee statement and a compliance verification document, with separate sections for interviewer review and payroll checker validation. Interviewers must document their observations regarding the employee's work classification, proper payment status, and wage poster compliance, while payroll checkers verify that interview information aligns with actual payroll data. The document includes fields for tracking deductions beyond taxes and social security, hours worked, tools utilized, and any discrepancies or comments requiring explanation. All dates are recorded in YYMMDD format, and the form requires signatures from both the employee and authorized personnel to certify accuracy. This form is essential for demonstrating prevailing wage compliance on the sidewalk repair project and ensuring that all workers receive required wage rates and benefits as mandated by federal labor standards.
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Text version
LABOR STANDARDS INTERVIEW
CONTRACT NUMBER EMPLOYEE INFORMATION
LAST NAME FIRST NAME MI
STREET ADDRESS
CITY STATE ZIP CODE
WORK CLASSIFICATION WAGE RATE
NAME OF PRIME CONTRACTOR
NAME OF EMPLOYER
SUPERVISOR'S NAME
LAST NAME FIRST NAME MI
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?
DATE OF LAST WORK DAY BEFORE INTERVIEW (YYMMDD)
DATE YOU BEGAN WORK ON THIS PROJECT (YYMMDD)
TOOLS YOU USE
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
ACTION (If explanation is needed, use comments section) YES NOWORK EMPLOYEE WAS DOING WHEN INTERVIEWED
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
DATE (YYMMDD)SIGNATURE
AUTHORIZED FOR LOCAL REPRODUCTION
Previous edition not usable
STANDARD FORM 1445 (REV. 12-96)
Prescribed by GSA - FAR (48 CFR) 53.222(g)
C:\PERFORM\FORMS\S1445.FRP
Barbara Williams
LABOR STANDARDS INTERVIEW
CONTRACT NUMBER
EMPLOYEE INFORMATION
LAST NAME
FIRST NAME
MI
STREET ADDRESS
CITY
STATE
ZIP CODE
WORK CLASSIFICATION
WAGE RATE
NAME OF PRIME CONTRACTOR
NAME OF EMPLOYER
SUPERVISOR'S NAME
LAST NAME
FIRST NAME
MI
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?
DATE OF LAST WORK DAY BEFORE INTERVIEW (YYMMDD)
DATE YOU BEGAN WORK ON THIS PROJECT (YYMMDD)
TOOLS YOU USE
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
ACTION (If explanation is needed, use comments section)
YES
NO
WORK EMPLOYEE WAS DOING WHEN INTERVIEWED
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
DATE (YYMMDD)
SIGNATURE
AUTHORIZED FOR LOCAL REPRODUCTION Previous edition not usable STANDARD FORM 1445 (REV. 12-96) Prescribed by GSA - FAR (48 CFR) 53.222(g)
| IS EMPLOYEE PROPERLY CLASSIFIED AND PAID? YES: 0 |
| IS EMPLOYEE PROPERLY CLASSIFIED AND PAID? NO: 0 |
| ARE WAGE RATES AND POSTERS DISPLAYED? YES: 0 |
| ARE WAGE RATES AND POSTERS DISPLAYED? NO: 0 |
| Do you work over 8 hours per day? YES: 0 |
| Do you work over 8 hours per day? NO: 0 |
| Do you work over 40 hours per week? YES: 0 |
| Do you work over 40 hours per week? NO: 0 |
| Are you paid at least time and a half for overtime hours? YES: 0 |
| Are you paid at least time and a half for overtime hours? NO: 0 |
| Are you receiving any cash payments for fringe benefits required by the posted wage determination decision? YES: 0 |
| Are you receiving any cash payments for fringe benefits required by the posted wage determination decision? NO: 0 |
| IS ABOVE INFORMATION IN AGREEMENT WITH PAYROLL DATA? NO: 0 |
| IS ABOVE INFORMATION IN AGREEMENT WITH PAYROLL DATA? YES: 0 |
| CONTRACT NUMBER: |
| NAME OF PRIME CONTRACTOR: |
| NAME OF EMPLOYER: |
| LAST NAME: |
| FIRST NAME: |
| mi1: |
| LAST NAME: |
| FIRST NAME: |
| STREET ADDRESS: |
| CITY: |
| WORK CLASSIFICATION: |
| STATE: |
| WAGE RATE: |
| ZIP CODE: |
| MIDDLE INITIAL: |
| 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. 1 of 6. : |
| TOOLS YOU USE. 2 of 6: |
| TOOLS YOU USE. 3 of 6: |
| TOOLS YOU USE. 4 of 6: |
| TOOLS YOU USE. 5 of 6: |
| TOOLS YOU USE. 6 of 6: |
| INTERVIEWER TYPED OR PRINTED NAME: |
| WORK EMPLOYEE WAS DOING WHEN INTERVIEWED: |
| COMMENTS: |
| LAST NAME: |
| FIRST NAME: |
| MIDDLE INITIAL: |
| JOB TITLE: |
| SIGNATURE: |
| SIGNATURE: |
| INTERVIEWER SIGNATURE: |
| INTERVIEWER SIGNATURE: |
| EMPLOYEE'S SIGNATURE: |
| EMPLOYEE'S SIGNATURE: |
| DATE OF LAST WORK DAY BEFORE INTERVIEW (YYMMDD). : |
| DATE YOU BEGAN WORK ON THIS PROJECT (YYMMDD). : |
| DATE (YYMMDD). : |
| DATE (YYMMDD). : |
| SIGNATURE DATE (YYMMDD). : |
File details come from the government source that posted it. Updated .