DWSRF_1445_Labor_Standards_Interview_Form.pdf
PDF 1005 KB Posted
- Attached to
- TRAFFIC SIGNAL MAINTENANCE
- Solicitation number
- 26/27-13
- Issued by
- Hartford County, Connecticut
About this file
This is a Standard Form 1445 Labor Standards Interview Form prescribed by the General Services Administration, designed for use in conjunction with the Town of Manchester, Connecticut's Traffic Signal Maintenance contract (Bid No. 26/27-13). The form serves as a compliance verification tool for projects subject to labor standards requirements, including prevailing wage determinations. The document functions as a template for conducting structured interviews with employees to verify proper wage classification, overtime compensation, and fringe benefit payments. The form captures comprehensive employee information including work classification, wage rates, daily and weekly hours worked, overtime compensation practices, and deductions from pay beyond standard taxes and social security withholdings.
The Labor Standards Interview Form includes verification sections completed by both employees and payroll checkers to ensure compliance with wage and labor standards. Key evaluation areas include confirmation that employees are properly classified and paid according to applicable wage determinations, overtime is compensated at a minimum rate of one and one-half times the regular rate for hours exceeding 40 per week or 8 per day, cash fringe benefit payments are made as required, and wage rate postings are displayed at the project site. The form requires interviewer and payroll checker signatures with accompanying dates and comments sections for documentation of compliance issues or explanations. All data fields indicate zero responses, suggesting this is a blank template authorized for local reproduction by the Town of Manchester for use throughout the contract period to maintain ongoing labor standards compliance documentation.
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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 .