CommunityAssistance(CA)
CommunityDevelopmentBlockGrant
Labor Standards Monitoring Form
Grantee: ______Grant Number: ______
Prepared by: ______Date Prepared: ______
Telephone Number: ______Email Address: ______
Position Name: ______
CommentsLabor Standards Administration
1. / a) Whorequeststhe wagedetermination?
b) Whoconductstheemployeeinterviews?
c) Whoreceivesandreviews thepayrollandverification ofwages?
Contract/Pre-Construction
2 / a) Type ofconstruction (e.g.streets, water, rehabilitationetc.?)
b) Name ofContractor:
c) Bidopening date:
d) Contractaward date:
e) Contractamount
f) Are Labor Standards provisions in the
contract?
(Attach copy of provision stating
they are in contract)
g) Isthe wagedecision in the contract?If yes, list the decision number(s):
(Attach copy of wage decision)
h) Doesthefilecontain certificationof contractor eligibility? (Attach Copy)
i)Are minutesofthe pre-construction
conference on file?(Attach Copy)
j) Dateofthe startofconstruction:
k) Hasthe recipientnotifiedCAofthe startofconstruction?
Payroll/Employee Interview Review
3 / a) How often were employee interviews conducted by the grantee?
b) Were a representative number of trades covered? (Attach interview documents)
c) Are payrolls submitted weekly?
d) Are payrolls numbered?
(Attach copy of all payrolls)
e) Are payrolls signed by the employer or authorized representative?
f) Are any workers paid as apprentices or trainees? If yes, does the file contain appropriate apprentice/trainee registration records?(Attach documents)
g) Were additional classifications
necessary?
h) Is payroll review correspondence in the file? (Attach copies)
Worker Sample 1
(Provide specific explanations for any No answers to questions f-i)
4 / a) Payroll Number:
b) Employee Name:
c) Rate Paid:
d) Classification:
e) Decision Rate:
f) Is the rate paid equal to or more than the wage rate on the wage decision for the classification?
g) Did the employee work more than 40
hours in the week? If yes, was the correct overtime paid?
h) Are all payroll deductions permissible under Labor Standards regulations?
I) Is there an employee interview for this employee? If yes, does the interview verify the correct work classification?
Worker Sample 2
(Provide specific explanations for any No answers to questions f-i)
5 / a) Payroll Number:
b) Employee Name:
c) Rate Paid:
d) Classification:
e) Decision Rate:
f) Is the rate paid equal to or more than the wage rate on the wage decision for the classification?
g) Did the employee work more than 40
hours in the week? If yes, was the correct overtime paid?
h) Are all payroll deductions permissible under Labor Standards regulations?
I) Is there an employee interview for this employee? If yes, does the interview verify the correct work classification?
Worker Sample 3
(Provide specific explanations for any No answers to questions f-i)
6 / a) Payroll Number:
b) Employee Name:
c) Rate Paid:
d) Classification:
e) Decision Rate:
f) Is the rate paid equal to or more than the wage rate on the wage decision for the classification?
g) Did the employee work more than 40
hours in the week? If yes, was the correct overtime paid?
h) Are all payroll deductions permissible under Labor Standards regulations?
I) Is there an employee interview for this employee? If yes, does the interview verify the correct work classification?
Site Visit
7 / a) Is the type of construction consistent with the contract documents and wage decision? (letter verifying)
b) Is the wage decision posted at the site of work in a prominent place readily accessible to workers? (submit pictures)
c) Is publication WH1321Notice to Employees posted? If yes, does it contain name and telephone number to contact if proper wages are not paid? (submit pictures)
List or attach supporting documentation or notate items reviewed to support work performed where deemed necessary for all questions listed on this monitoring checklist.
______
Grantee RepresentativeDate
(Sign and date once you have completed form)
______
Grant Management RepresentativeDate
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RevisedOctober 2014