DWSRF_1445_Labor_Standards_Interview_Form.pdf

1005 KB Posted

Attached to
POST TOP LED STREETLIGHT REPLACEMENTS
Solicitation number
23/24-104
Issued by
Hartford County, Connecticut

About this file

Written by GovTribe AI ·

The document is a Standard Form 1445 Labor Standards Interview form, which is a federal government document used to verify labor compliance on contract projects. The form is designed to collect detailed information about an employee's work conditions, hours, wages, and job classifications during a government contract. It includes sections for recording employee personal details, work information, overtime status, wage rates, and fringe benefits, with spaces for both the employee and an interviewer to provide information and validate responses.

This specific form appears to be blank and ready for use, with fields to document contract number, employer information, work classification, wage rates, overtime details, and potential deductions. The form is prescribed by the General Services Administration (GSA) and is part of the Federal Acquisition Regulation (FAR) process to ensure labor standards compliance, with sections for employee self-reporting, interviewer comments, and subsequent payroll verification. While directly linked to the Manchester, Connecticut post-top LED streetlight replacement project, this form represents a standard federal labor compliance tool used to protect worker rights and ensure proper compensation and classification on government-funded projects.

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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 .