Form BOFE1 "Report of Labor Law Violation" - California

What Is Form BOFE1?

This is a legal form that was released by the California Department of Industrial Relations - Division of Labor Standards Enforcement - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the California Department of Industrial Relations - Division of Labor Standards Enforcement;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BOFE1 by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Labor Standards Enforcement.

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LABOR COMMISSIONER, STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS - DIVISION OF LABOR STANDARDS ENFORCEMENT
BUREAU OF FIELD ENFORCEMENT
NO ☐ YES ☐
OFFICE USE ONLY
IS THIS REPORT RELATED TO COVID-19?
NO ☐ YES ☐
TAKEN BY: _________ DATE FILED: __________________ INDUSTRY:__________________
RELATED TO PAID SICK LEAVE (PSL/SPSL)?
Please print legibly or type. Fill out this form if you would like to report a widespread violation of workplace laws (e.g., wage and hour, child
labor, workers’ compensation, or recordkeeping laws) by an employer that affects all or a group of employees working for the employer. If
you are claiming only unpaid wages on behalf of yourself and do not wish to report a widespread violation of the law by your employer that
also affects other workers, then fill out the DLSE Form 1 (Initial Report or Claim) to file an individual wage claim, instead of this form.
REPORT OF LABOR LAW VIOLATION
SECTION 1. REPORTING PARTY (INDIVIDUAL OR REPRESENTATIVE)
NAME OF REPORTING PARTY: ___________________________________ IF INTERPRETER IS NEEDED, INDICATE LANGUAGE:___________________
ADDRESS: _______________________________________________________ CITY:___________________ STATE:________ ZIP:______________
HOME PHONE: (_____)_______________ CELL/OTHER PHONE: (_____)________________ E-MAIL (if available): ___________________________
If you are represented by a lawyer or other advocate, enter your ADVOCATE and ORGANIZATION information:
NAME: ___________________________________ ORGANIZATION NAME:___________________________________________________________
ADDRESS: _______________________________________________ CITY:___________________________ STATE:________ ZIP:______________
HOME PHONE: (_____)_______________ CELL/OTHER PHONE: (______)_______________ E-MAIL (if available): ___________________________
SECTION 2. EMPLOYER REPORTED
EMPLOYER BUSINESS NAME: ________________________________________________________________________________________________
ADDRESS: ________________________________________________________ CITY: ________________ STATE:______ ZIP: __________________
PHONE: (____)_________________ TYPE OF BUSINESS: _____________________________________________ TOTAL EMPLOYEES: ___________
________________
ENTITY TYPE: CORPORATION
 INDIVIDUAL
 PARTNERSHIP
 LLC
 LLP
 OTHER (explain): ____
OWNER’S NAME: _______________________ NAME AND JOB TITLE OF PERSON IN CHARGE: ____________________________________________
ADDRESS
EMPLOYER STILL
BUSINESS
TOTAL
CITY, STATE, ZIP
OPERATING THERE?
HOURS
EMPLOYEES
EMPLOYER’S MAIN WORK LOCATION
 YES
 NO
 UNKNOWN
OTHER WORK LOCATION
 YES
 NO
(if any, whether or not you worked there)
 UNKNOWN
OTHER WORK LOCATION
 YES
 NO
(if any, whether or not you worked there)
 UNKNOWN
IS THE EMPLOYER COVERED BY WORKERS’ COMPENSATION INSURANCE?  YES
 NO
 UNKNOWN
IS THERE A UNION CONTRACT?  YES
 NO
DID YOUR JOB INVOLVE PUBLIC WORKS?  YES
 NO
EMPLOYER’S VEHICLE LICENSE PLATE NUMBER: _____________________________________
SECTION 3. WORK HOURS AND WAGES
DO YOU OR DID YOU WORK FOR THE EMPLOYER?  YES
 NO
IF “YES”:
DATE OF HIRE: ______ / _____ /______ LAST DAY OF WORK (if applicable): _____/______/______  QUIT
 FIRED
STILL EMPLOYED
DID THE EMPLOYER DESIGNATE WHAT TIME THE WORKDAY BEGAN FOR EMPLOYEES?  YES
 NO
 DON’T KNOW
IF “YES”:
WHAT TIME DID THE EMPLOYER DESIGNATE? _______  AM  PM
DID THE EMPLOYER DESIGNATE WHICH DAY OF THE WEEK THE WORKWEEK BEGAN?  YES
 NO
 DON’T KNOW
IF “YES”:
WHAT DAY DID THE EMPLOYER DESIGNATE?  SUNDAY  MONDAY  TUESDAY  WEDNESDAY  THURSDAY  FRIDAY SATURDAY
WHAT IS THE NORMAL OR STANDARD WORK SCHEDULE FOR EMPLOYEES DURING THE WEEK? PROVIDE YOUR BEST ESTIMATE OF THE START AND
END TIMES AND NUMBER OF HOURS WORKED FOR EACH WORK DAY. (If employees did not work standard schedules, skip to the next question.)
SUNDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
HOURS WORKED: ________
MONDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
HOURS WORKED: ________
TUESDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
TOTAL HOURS
HOURS WORKED: ________
WEDNESDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
WORKED PER
HOURS WORKED: ________
THURSDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
WEEK:
HOURS WORKED: ________
FRIDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
________
HOURS WORKED: ________
SATURDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
HOURS WORKED: ________
BOFE 1 (Rev. 9/2020)
Page 1 of 3
CLEAR
PRINT
LABOR COMMISSIONER, STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS - DIVISION OF LABOR STANDARDS ENFORCEMENT
BUREAU OF FIELD ENFORCEMENT
NO ☐ YES ☐
OFFICE USE ONLY
IS THIS REPORT RELATED TO COVID-19?
NO ☐ YES ☐
TAKEN BY: _________ DATE FILED: __________________ INDUSTRY:__________________
RELATED TO PAID SICK LEAVE (PSL/SPSL)?
Please print legibly or type. Fill out this form if you would like to report a widespread violation of workplace laws (e.g., wage and hour, child
labor, workers’ compensation, or recordkeeping laws) by an employer that affects all or a group of employees working for the employer. If
you are claiming only unpaid wages on behalf of yourself and do not wish to report a widespread violation of the law by your employer that
also affects other workers, then fill out the DLSE Form 1 (Initial Report or Claim) to file an individual wage claim, instead of this form.
REPORT OF LABOR LAW VIOLATION
SECTION 1. REPORTING PARTY (INDIVIDUAL OR REPRESENTATIVE)
NAME OF REPORTING PARTY: ___________________________________ IF INTERPRETER IS NEEDED, INDICATE LANGUAGE:___________________
ADDRESS: _______________________________________________________ CITY:___________________ STATE:________ ZIP:______________
HOME PHONE: (_____)_______________ CELL/OTHER PHONE: (_____)________________ E-MAIL (if available): ___________________________
If you are represented by a lawyer or other advocate, enter your ADVOCATE and ORGANIZATION information:
NAME: ___________________________________ ORGANIZATION NAME:___________________________________________________________
ADDRESS: _______________________________________________ CITY:___________________________ STATE:________ ZIP:______________
HOME PHONE: (_____)_______________ CELL/OTHER PHONE: (______)_______________ E-MAIL (if available): ___________________________
SECTION 2. EMPLOYER REPORTED
EMPLOYER BUSINESS NAME: ________________________________________________________________________________________________
ADDRESS: ________________________________________________________ CITY: ________________ STATE:______ ZIP: __________________
PHONE: (____)_________________ TYPE OF BUSINESS: _____________________________________________ TOTAL EMPLOYEES: ___________
________________
ENTITY TYPE: CORPORATION
 INDIVIDUAL
 PARTNERSHIP
 LLC
 LLP
 OTHER (explain): ____
OWNER’S NAME: _______________________ NAME AND JOB TITLE OF PERSON IN CHARGE: ____________________________________________
ADDRESS
EMPLOYER STILL
BUSINESS
TOTAL
CITY, STATE, ZIP
OPERATING THERE?
HOURS
EMPLOYEES
EMPLOYER’S MAIN WORK LOCATION
 YES
 NO
 UNKNOWN
OTHER WORK LOCATION
 YES
 NO
(if any, whether or not you worked there)
 UNKNOWN
OTHER WORK LOCATION
 YES
 NO
(if any, whether or not you worked there)
 UNKNOWN
IS THE EMPLOYER COVERED BY WORKERS’ COMPENSATION INSURANCE?  YES
 NO
 UNKNOWN
IS THERE A UNION CONTRACT?  YES
 NO
DID YOUR JOB INVOLVE PUBLIC WORKS?  YES
 NO
EMPLOYER’S VEHICLE LICENSE PLATE NUMBER: _____________________________________
SECTION 3. WORK HOURS AND WAGES
DO YOU OR DID YOU WORK FOR THE EMPLOYER?  YES
 NO
IF “YES”:
DATE OF HIRE: ______ / _____ /______ LAST DAY OF WORK (if applicable): _____/______/______  QUIT
 FIRED
STILL EMPLOYED
DID THE EMPLOYER DESIGNATE WHAT TIME THE WORKDAY BEGAN FOR EMPLOYEES?  YES
 NO
 DON’T KNOW
IF “YES”:
WHAT TIME DID THE EMPLOYER DESIGNATE? _______  AM  PM
DID THE EMPLOYER DESIGNATE WHICH DAY OF THE WEEK THE WORKWEEK BEGAN?  YES
 NO
 DON’T KNOW
IF “YES”:
WHAT DAY DID THE EMPLOYER DESIGNATE?  SUNDAY  MONDAY  TUESDAY  WEDNESDAY  THURSDAY  FRIDAY SATURDAY
WHAT IS THE NORMAL OR STANDARD WORK SCHEDULE FOR EMPLOYEES DURING THE WEEK? PROVIDE YOUR BEST ESTIMATE OF THE START AND
END TIMES AND NUMBER OF HOURS WORKED FOR EACH WORK DAY. (If employees did not work standard schedules, skip to the next question.)
SUNDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
HOURS WORKED: ________
MONDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
HOURS WORKED: ________
TUESDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
TOTAL HOURS
HOURS WORKED: ________
WEDNESDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
WORKED PER
HOURS WORKED: ________
THURSDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
WEEK:
HOURS WORKED: ________
FRIDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
________
HOURS WORKED: ________
SATURDAY
START TIME: ________  AM  PM
END TIME: _______  AM  PM
HOURS WORKED: ________
BOFE 1 (Rev. 9/2020)
Page 1 of 3
SECTION 3. WORK HOURS AND WAGES (continued)
DO EMPLOYEES WORK DIFFERENT SCHEDULES OR IRREGULAR HOURS SO YOU CANNOT PROVIDE A STANDARD WORK SCHEDULE?  YES  NO
IF “YES,” BRIEFLY DESCRIBE THE DIFFERENT SCHEDULES OR IRREGULAR WORK HOURS AS BEST AS YOU CAN: ____________________________
____________________________________________________________________________________________________________________
WHEN IS THE NORMAL OR STANDARD SCHEDULED MEAL PERIOD FOR EMPLOYEES?
START TIME: _________  AM  PM
END TIME: _________  AM  PM
THERE IS NO STANDARD SCHEDULED MEAL PERIOD
WHAT IS THE AVERAGE LENGTH OF TIME FOR AN EMPLOYEE’S MEAL PERIOD? ________
 HOURS
MINUTES
WHO SET THE WORK SCHEDULE? (FULL NAME AND JOB TITLE/POSITION): ____________________________________________________________
WHAT DAY IS PAY DAY?
DAILY
WEEKLY ON __________________________
BI-WEEKLY ON
__________________________
(Once every two weeks)
MONTHLY ON ________________________
SEMI-MONTHLY ON
____________________________
(Twice a month)
WHO PAYS EMPLOYEES? (FULL NAME AND JOB TITLE/POSITION): ___________________________________________________________________
ARE EMPLOYEES PAID BY THE HOUR?  YES  NO
IF “YES,” HOW MUCH? $ __________ PER HOUR
VARIES (EXPLAIN):_____________________________________________________________________________________________________
ARE EMPLOYEES PAID A FIXED AMOUNT OF WAGES (OR SALARY), REGARDLESS OF THE NUMBER OF HOURS WORKED?  YES  NO
IF “YES,” HOW MUCH? $ ___________  PER DAY
 PER WEEK
 EVERY 2 WEEKS
 SEMI-MONTHLY
 MONTHLY
VARIES (EXPLAIN):_____________________________________________________________________________________________________
ARE EMPLOYEES PAID BY PIECE RATE?  YES  NO
IF “YES,” HOW MUCH? $ ________ PER (Describe Unit) ___________________________
PIECE RATES VARY (EXPLAIN): ____________________________________________________________________________________________
HOW ARE EMPLOYEES PAID?  CHECK
 CASH
 BOTH CHECK & CASH
 OTHER METHOD (EXPLAIN): ________________________________________________
 METHOD OF PAYMENT VARIES PER EMPLOYEE OR JOB POSITION (EXPLAIN): _______________________________
______________________________________________________________________________________________
IF EMPLOYEES ARE PAID IN CASH, DOES THE EMPLOYER KEEP CASH PAYMENT RECORDS OR LOGS?  YES  NO
 DON’T KNOW
DOES THE EMPLOYER KEEP TIME RECORDS OF HOURS WORKED BY EMPLOYEES?  YES  NO
 DON’T KNOW
WHAT LANGUAGES ARE SPOKEN BY EMPLOYEES?  ENGLISH  SPANISH  MIXTEC  TRIQUE  CANTONESE  MANDARIN  KOREAN
 VIETNAMESE  TAGALOG  CAMBODIAN  HMONG  THAI  PUNJABI
 HINDI
 RUSSIAN
 OTHER: _____________
SECTION 4. SUSPECTED VIOLATIONS OF EMPLOYER
The boxes below describe conduct by an employer that violates the law. Please put a check mark in the box(es) if the employer
engages in, or any employee or employees have experienced, any of the following violations:
 NO WORKERS’ COMPENSATION INSURANCE
 CHILD LABOR VIOLATIONS:
 No valid work permit(s)
 No valid entertainment work permit(s)
 Minor(s) work excessive or prohibited hours
 Minor(s) work in hazardous conditions
Estimated number of minors affected: _________
 MINIMUM WAGE VIOLATIONS:
 OVERTIME VIOLATIONS:
 Paid below minimum wage
 Not paid daily overtime for hours worked over 8 hours per
 Not paid at all for overtime hours worked
day (or 10 hours per day for farmworkers)
 Not paid for all hours worked, including unpaid travel time and
 Not paid weekly overtime for hours worked over 40 hours
try-out time
per week
 Paycheck issued with insufficient funds
 Not paid double time for hours worked over 12 hours per
 Asked employee to pay back wages paid
day
 No split shift premium pay
 Not paid overtime for working on the 7th consecutive
workday in a workweek
Estimated number of employees affected: _________
Estimated number of employees affected: _________
BOFE 1 (Rev. 9/2020)
Page 2 of 3
SECTION 4. SUSPECTED VIOLATIONS OF EMPLOYER (continued)
 OTHER UNPAID WAGES:
 PAY STUB VIOLATIONS:
 Wages are not paid at the contracted rate
 Paid by check or cash without an itemized wage deduction
 No reporting time premium pay
statement
 No premium pay for missing meal or rest periods
 Itemized wage deduction statement provided but not
accurate and/or incomplete
Estimated number of employees affected: _________
 Itemized wage deduction statement not provided at least
semi-monthly
Estimated number of employees affected: _________
 MEAL PERIOD VIOLATIONS:
 REST BREAK VIOLATIONS:
 30-minute off-duty meal period not provided by the end of the
 For work days between 3.5 hours and up to 6 hours per day,
5th hour of work
not allowed to take a 10-minute rest break
 Second 30-minute off-duty meal period not provided when
 For work days of more than 6 hours and up to 10 hours per
working more than 10 hours
day, not allowed to take two 10-minute rest breaks
 Meal period provided but less than 30 minutes
 For work days of more than 10 hours and up to 14 hours
per day, not allowed to take three 10-minute rest breaks
Estimated number of employees affected: _________
Estimated number of employees affected: _________
 PAY DATE VIOLATIONS:
 RECORD KEEPING VIOLATIONS:
 No fixed pay date
 Daily time records are not kept or inaccurate
 Late payment of wages
 Payroll records are not kept or inaccurate
 No notice to new hires (under Labor Code Section 2810.5)
Estimated number of employees affected: _________
 BUSINESS EXPENSE VIOLATIONS:
 FAILURE TO POST:
 Uniforms not reimbursed or illegally charged to employees
 Applicable Industrial Welfare Commission Order not posted
 Tools, supplies or equipment not reimbursed or illegally charged
 Minimum Wage Order 2001 not posted
to employees
 Pay day notice not posted
 Illegal charges for cash shortages, breakage, or loss of
 Workers’ compensation insurance notice not posted
equipment
 Rate of compensation not posted (for farmworkers only)
Estimated number of employees affected: _________
 MISCLASSIFICATION:
 LICENSING/REGISTRATION VIOLATIONS:
 Employees misclassified as independent contractors
 Unlicensed construction contractor
 Salaried employees misclassified as exempt employees
 Contracted with unlicensed construction contractor
 Unlicensed farm labor contractor
Estimated number of employees affected: _________
 Unregistered garment contractor or manufacturer
 Unregistered car wash
 FAILURE TO PROVIDE LACTATION ACCOMMODATIONS
 OTHER VIOLATIONS
(briefly explain):
___________________________________________
Estimated number of employees affected: _________
Estimated number of employees affected: _________
Please provide any other information about your complaint that you believe is important for the Labor Commissioner to know:
Please provide the following information for any minors under the age of 18 who work for the employer:
FULL NAME
AGE
JOB POSITION/ TYPE OF
NORMAL WORK SCHEDULE
HOW WAS THE MINOR PAID
(first and last name, and
WORK PERFORMED
(by check, in cash, both cash and
any “nick” names)
check, or other method)?
MAY YOUR NAME BE USED IN AN INVESTIGATION?  YES
 NO
DO YOU WANT DLSE TO KEEP YOUR NAME AND CONTACT INFORMATION CONFIDENTIAL? *  YES
 NO
I HEREBY CERTIFY THAT THE INFORMATION ABOVE IS A TRUE STATEMENT TO THE BEST OF MY KNOWLEDGE.
SIGNED: ______________________________________________
DATE: ________________________________________
PRINT NAME: __________________________________________
* DLSE will maintain confidentiality as appropriate in each case and to the extent provided for under the law. Information may need to be released in some cases.
BOFE 1 (Rev. 9/2020)
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