Standard Form 1445 Labor Standards Interview

LABOR STANDARDS INTERVIEW
CONTRACT NUMBER

EMPLOYEE INFORMATION
FIRST NAME

LAST NAME

MI

NAME OF PRIME CONTRACTOR
STREET ADDRESS
NAME OF EMPLOYER
ZIP CODE

CITY

STATE

WORK CLASSIFICATION

WAGE RATE

SUPERVISOR'S NAME
MI

FIRST NAME

LAST NAME

CHECK BELOW
YES
NO

ACTION
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

INTERVIEWER

DATE (YYMMDD)

SIGNATURE

TYPED OR PRINTED NAME

WORK EMPLOYEE WAS DOING WHEN INTERVIEWED

DATE (YYMMDD)

INTERVIEWER'S COMMENTS
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
SIGNATURE

AUTHORIZED FOR LOCAL REPRODUCTION
Previous edition not usable

FIRST NAME

MI

JOB TITLE
DATE (YYMMDD)

STANDARD FORM 1445

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