Employee Interview Form - Labor Page 2
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4700-010-63
CONSTRUCTION
04/15
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
EMPLOYEE INTERVIEW FORM-LABOR
“Confidential: All information in this form shall remain confidential to the extent permitted by law, including Florida Statutes Chapter 119”
Section C - INTERVIEWER’S OBSERVATION
H.
Describe employee’s work you observed at time of interview.
I.
List/describe the tools/equipment the employee was using/operating.
No Tools
No Equip
Interviewer Comments
J.
Section D – RCS’ REVIEW & ACTION
K.
RCS
First & Last Name
Date
L.
Payroll vs. Wage Determination Minimum Rate and Fringe
As shown on Payroll:
As indicated in observation (“H” and “I”):
Classification
Classification
Rate Paid
Fringe Paid
Total
Rate Minimum
Fringe Minimum
Total
WD Rate
WD Fringe
WD Total
Is the classification shown on the payroll equal to or greater than
the classification as observed (“H” and “I”)?
Yes
No
If Fringe Benefits are required, how are they paid to the employee?
NA – not required
Cash
Benefits
Combination
M.
Are there any discrepancies between work observed, tools and equipment used, classification and rate of pay?
Yes
No If yes, please explain.
Discrepancy:
Was a payroll violation issued?
Improper Classification
Yes
Code #
Wages paid
No
Not Listed on payroll
Other:
N.
Any concerns from Section 2 or 3?
Yes
No
O.
Comments
N/A
P.
Payroll Correction received if applicable:
Date
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