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LABOR STANDARDS INTERVIEW <br /> CONTRACT NUMBER AND LOCATION EMPLOYEE INFORMATION <br /> LAST NAME FIRST NAME MI <br /> NAME OF PRIME CONTRACTOR STREET ADDRESS <br /> NAME OF EMPLOYER CITY STATE 7 CODE <br /> ' SUPERVISOR'S NAME WORK CLASSIFICATION WAGE RATE <br /> LAST NAME FIRST NAME MI <br /> ACTION CHECK BELOW <br /> YES NO <br /> Do you work over 8 hours per day? <br /> Do you work over 40 hours per week? <br /> Are you paid at least time and a half for overtime hours? <br /> Are you paid for all hours worked? <br /> Do you receive a 30-minute break for every 6 hours worked? <br /> Have you ever been threatened or coerced into giving up any part of your pay? <br /> Are you receiving any cash payments for fringe benefits required by the posted wage determination decision? <br /> Examples of'bona fide"fringe benefits include(but are not limited to)life insurance,health insurance,pension,vacation,holidays,and sick leave <br /> WHAT DEDUCTIONS OTHER THAN TAXES AND SOCIAL SECURITY ARE MADE FROM YOUR PAY? <br /> HOW MANY HOURS DID YOU WORK ON YOUR LAST WORK DAY DUTIES PERFORMED TOOLS USED <br /> BEFORE THIS INTERVIEW? <br /> DATE OF LAST WORK DAY BEFORE INTERVIEW(YYMMDD) <br /> WHEN DID YOU BEGIN WORK ON THIS PROJECT?(YYMMDD) <br /> I HAVE READ THE ABOVE AND CERTIFY IT TO BE CORRECT TO THE BEST OF MY KNOWLEDGE <br /> ' EMPLOYEE'S SIGNATURE DATE (YYMMDD) <br /> X <br /> INTERVIEWER'S SIGNATURE DATE (YYMMDD) <br /> INTERVIEWER'S COMMENTS <br /> WORK EMPLOYEE WAS DOING WHEN INTERVIEWED ACTION(Ifexplanafron is needed,use comments section) YES NO <br /> IS EMPLOYEE PROPERLY CLASSIFIED AND PAID? <br /> ARE WAGE RATES AND POSTERS DISPLAYED? <br /> FOR USE BY PAYROLL CHECKER <br /> IS ABOVE INFORMATION IN AGREEMENT WITH PAYROL DATA? ❑YES F-1 NO <br /> COMMENTS <br /> CHECKER <br /> LAST NAME FIRST NAME MI JOB TITLE <br /> SIGNATURE DATE(YYMMDD) <br /> AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1445(REV.7-06) <br />