Form SFN9426 "Labor Compliance Interview Questionaire (Site Interview)" - North Dakota

What Is Form SFN9426?

This is a legal form that was released by the North Dakota Department of Transportation - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2016;
  • The latest edition provided by the North Dakota Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN9426 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Transportation.

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Download Form SFN9426 "Labor Compliance Interview Questionaire (Site Interview)" - North Dakota

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LABOR COMPLIANCE INTERVIEW QUESTIONAIRE (SITE INTERVIEW)
North Dakota Department of Transportation, Civil Rights
SFN 9426 (4-2016)
INTERVIEWER: Labor compliance interviews (site interviews) should be conducted on all federal-aid highway construction
contractors annually. You should interview a cross-section of project employees on at least one job per district for each contractor.
If possible, interview 5 employees, with a cross section of the workforce, including women, minorities, and individuals with limited
English proficiency (LEP). The Department's telephonic interpreter service is available for interviewing employees with limited
English proficiency via cell phone. The phone number and instructions must be obtained from the District Office. Please call Civil
Rights Division at (701)328-2605 for assistance and guidance on job-site interviews. Until further notice, input this form into
CARS, and not LCPtracker.
PART A - PROJECT INFORMATION
Project Number
District
PCN
Name of Interviewer
Title of Interviewer
Date of Interview
Contractor Name
Contractor Type
If Subcontractor, Name of Prime
PART B - LABOR COMPLIANCE INTERVIEW DATA
1.
Employee Name
Telephone Number
2.
Job classification
3.
Yes
No
Do you know your minimum wage rate?
4.
Straight Time
Overtime
Actual Rate of Pay:
5.
Does not apply
What is your fringe benefit amount?
6.
If applicable, are fridge benefits paid to you in cash or does the contractor pay them into approved plans, Funds
Cash
Funds
or programs?
Yes
No
Have you experienced any problems?
If yes, describe:
7.
How often are you paid?
Weekly
Other
(specify):
8.
Other than the required deductions for social security and federal with holding tax, are other deductions
being made to your paycheck?
State Tax
Union Dues
Insurance
Pension
Other
(specify):
Yes
No
9. Did you pay a fee to secure this job?
10.
Are you required to return any of your wages to your employer?
Yes
No
If yes, for what reason:
11.
Dates employed on this project:
From
To
Supervisor's Name
12.
13.
How is your Time reported?
Daily Time Card
Weekly Time Card
Verbal
Other (specify):
14.
Yes
No
Do you have a wage grievance based on the above question?
Additional Comments
15.
LABOR COMPLIANCE INTERVIEW QUESTIONAIRE (SITE INTERVIEW)
North Dakota Department of Transportation, Civil Rights
SFN 9426 (4-2016)
INTERVIEWER: Labor compliance interviews (site interviews) should be conducted on all federal-aid highway construction
contractors annually. You should interview a cross-section of project employees on at least one job per district for each contractor.
If possible, interview 5 employees, with a cross section of the workforce, including women, minorities, and individuals with limited
English proficiency (LEP). The Department's telephonic interpreter service is available for interviewing employees with limited
English proficiency via cell phone. The phone number and instructions must be obtained from the District Office. Please call Civil
Rights Division at (701)328-2605 for assistance and guidance on job-site interviews. Until further notice, input this form into
CARS, and not LCPtracker.
PART A - PROJECT INFORMATION
Project Number
District
PCN
Name of Interviewer
Title of Interviewer
Date of Interview
Contractor Name
Contractor Type
If Subcontractor, Name of Prime
PART B - LABOR COMPLIANCE INTERVIEW DATA
1.
Employee Name
Telephone Number
2.
Job classification
3.
Yes
No
Do you know your minimum wage rate?
4.
Straight Time
Overtime
Actual Rate of Pay:
5.
Does not apply
What is your fringe benefit amount?
6.
If applicable, are fridge benefits paid to you in cash or does the contractor pay them into approved plans, Funds
Cash
Funds
or programs?
Yes
No
Have you experienced any problems?
If yes, describe:
7.
How often are you paid?
Weekly
Other
(specify):
8.
Other than the required deductions for social security and federal with holding tax, are other deductions
being made to your paycheck?
State Tax
Union Dues
Insurance
Pension
Other
(specify):
Yes
No
9. Did you pay a fee to secure this job?
10.
Are you required to return any of your wages to your employer?
Yes
No
If yes, for what reason:
11.
Dates employed on this project:
From
To
Supervisor's Name
12.
13.
How is your Time reported?
Daily Time Card
Weekly Time Card
Verbal
Other (specify):
14.
Yes
No
Do you have a wage grievance based on the above question?
Additional Comments
15.
SFN 9426
Page of
PART C - INTERVIEW VERIFICATION
1.
The following is based on visual observation only. DO NOT ask the individual if he or she is one of the mentioned categories.
Other
Male
Minority:
Disadvantaged
(disability, age, etc.)
(specify):
Female
Black
Hispanic
American Indian
Asian/Pacific Islander
2.
What type of work was actually being done by the employee when interviewed?
3.
Are the following wage, classification, and other required posters displayed on the project site?
Posterboard provided by the Department of Transportation (DOT 3350)
Labor Rates from the U.S. Department of Labor
Contractor's discrimination complaint procedure
Yes
No
4.
Is the employee properly classified:
5.
Yes
No
Is the employee properly paid
6.
If payroll deductions are being make that are not required by law or authorized without permission,
None
Yes
No
dose the contractor have written authorization to make those deductions?
(Authorized deductions normally consist of federal and state withholding tax; social security; fringe benefits such as retirement funds,
vacation pay, and sick leave pay; or any other deduction which is voluntarily consented to by the employee and where the employer
receives no interest or discount. Direct advancement wages or deductions of reasonable costs for food or lodging by the contractor are
authorized.)
7.
Does the classification, duties, and wage information provided by the employee correspond to the field office
Yes
No
records?
If no, list office information:
8.
Remarks (attach any discrepancies noted and action taken)
Classification and Wages Verification
Payroll Number
For the Week Ending
Verified By
Date
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