DHEC Form 2323 "Equal Employment Opportunity (EEO) Documentation Form" - South Carolina

What Is DHEC Form 2323?

This is a legal form that was released by the South Carolina Department of Health and Environmental Control - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2020;
  • The latest edition provided by the South Carolina Department of Health and Environmental Control;
  • 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 DHEC Form 2323 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Health and Environmental Control.

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Download DHEC Form 2323 "Equal Employment Opportunity (EEO) Documentation Form" - South Carolina

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Equal Employment Opportunity (EEO)
Documentation Form
SRF Project Number ________________________
Project Name ______________________________________________ Division ________________
Project Sponsor ____________________________________________________________________
This form is required of Prime Contractors and any Subcontractors with subcontracts valued at $10,000 or greater for
SRF equivalency projects only.
1. Proposed Prime Contractor or Subcontractor: ___________________________________________
Address: ________________________________________________________________________
Telephone Number: ___________________________________
2. Fill out and attach “Certification by Proposed Prime or Subcontractor Regarding Equal Employment
Opportunity” (DHEC Form 3592). ____ Attached
3. Attach a copy of the Employer Information Report EEO-1 (also known as Standard Form 100) if the
firm meets the criteria outlined on page 3. ____ Attached, or ____ N/A (Check N/A if the firm does
not meet the EEO-1 Report criteria.)
4.a.
Name of company official responsible for EEO: ____________________________________
Attach a copy of the contractor’s Affirmative Action Plan. ____ Plan attached, or ____ Letter
b.
attached stating subcontractor will be using the prime’s Affirmative Action Plan
5.a.
List current construction contracts, with dollar amount: (Attach a separate sheet if needed.)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
b.
List contracting federal agencies, if applicable:
____________________________________________________________________________
____________________________________________________________________________
6. Detail the sex and race/ethnic composition of the company’s workforce, temporary and permanent,
by job category. List statistics by percent or number.
African
Native
Job Category
Male
Female
American
Asian
Hispanic
American
White
Number of Disabled: _____
DHEC 2323 (8/2020)
S.C. Department of Health and Environmental Control
Page 1
Equal Employment Opportunity (EEO)
Documentation Form
SRF Project Number ________________________
Project Name ______________________________________________ Division ________________
Project Sponsor ____________________________________________________________________
This form is required of Prime Contractors and any Subcontractors with subcontracts valued at $10,000 or greater for
SRF equivalency projects only.
1. Proposed Prime Contractor or Subcontractor: ___________________________________________
Address: ________________________________________________________________________
Telephone Number: ___________________________________
2. Fill out and attach “Certification by Proposed Prime or Subcontractor Regarding Equal Employment
Opportunity” (DHEC Form 3592). ____ Attached
3. Attach a copy of the Employer Information Report EEO-1 (also known as Standard Form 100) if the
firm meets the criteria outlined on page 3. ____ Attached, or ____ N/A (Check N/A if the firm does
not meet the EEO-1 Report criteria.)
4.a.
Name of company official responsible for EEO: ____________________________________
Attach a copy of the contractor’s Affirmative Action Plan. ____ Plan attached, or ____ Letter
b.
attached stating subcontractor will be using the prime’s Affirmative Action Plan
5.a.
List current construction contracts, with dollar amount: (Attach a separate sheet if needed.)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
b.
List contracting federal agencies, if applicable:
____________________________________________________________________________
____________________________________________________________________________
6. Detail the sex and race/ethnic composition of the company’s workforce, temporary and permanent,
by job category. List statistics by percent or number.
African
Native
Job Category
Male
Female
American
Asian
Hispanic
American
White
Number of Disabled: _____
DHEC 2323 (8/2020)
S.C. Department of Health and Environmental Control
Page 1
7. Check applicable employment sources:
____Newspaper Advertisement
____Trade Schools
____Job Service
____Trade Associations
____Walk-In Applications
____Other: _______________________
____Employee Referrals
8. List anticipated employment needs for this project, indicating percentage or number of
female/minority participation in each trade:
African
Native
Trade
Female
American
Asian
Hispanic
American
OR
____ Check here if you plan to only use your existing workforce.
9. Prime Contractors Only: Fill out and attach “Prime Contractor’s Subagreement Certification”
(DHEC Form 3591). ____ Attached
10. Contract Price: $_______________
11. Duration of Contract: ______________
12. All Prime Contractors and Subcontractors when the subcontract equals or exceeds $25,000:
Fill out and attach “Certification Regarding Debarment, Suspension and Other Responsibility
Matters” (DHEC Form 3590). _____ Attached, or _____ NA (Subcontract is < $25,000)
__________________________________________________________________________________
Signature of Authorized Official
__________________________________________________________________________________
Printed Name and Title of Authorized Official
Date
Submit by email to DHEC project manager or by mail to:
SRF Section - Water Facilities Permitting Division, S.C. DHEC, 2600 Bull Street, Columbia, SC 29201
DHEC 2323 (8/2020)
S.C. Department of Health and Environmental Control
Page 2
Instructions – DHEC 2323
PURPOSE: The EEO Documentation Form is used to document compliance with Equal Employment
Opportunity (EEO) requirements, which prohibit discrimination in employment practices on the basis of
race, color, religion, national origin, sex, age or handicap. The affirmative action program is designed to
enhance hiring, training, and promotion opportunities for minorities and women and is governed by
Executive Order 11246. EEO compliance applies to State Revolving Fund (SRF) projects designated
as equivalency projects.
INSTRUCTIONS: This form must be completed by each prime contractor and any subcontractor whose
contract amount exceeds $10,000 for SRF equivalency projects only.
Enter the requested project information and answer each question. Submit any requested attachments
with this form.
DHEC REVIEW AND FILING: The SRF Section will use this form to document prime contractor and
subcontractor compliance with the EEO requirements. The form will be kept in the DBE/EEO file for the
named project and will be retained for three years following the final SRF disbursement to the project’s
Sponsor - per Retention Schedule 15795.
RE: Employer Information - Report EEO-1
Under the direction of the U.S. Equal Employment Opportunity Commission (EEOC), the Joint
Reporting Committee (JRC) is responsible for the full-length, multi-phase processing of employment
statistics collected on the Employer Information Report EEO-1. This report, also known as Standard
Form 100, details the sex and race/ethnic composition of an employer’s work force by job category.
The Employer Information EEO-1 survey is conducted annually under the authority of Public Law 88-
352, Title VII of the Civil Rights Act of 1964, as amended by the Equal Employment Opportunity Act of
1972. All employers with 15 or more employees are covered by Public Law 88-352 and are required to
keep employment records as specified by Commission regulations. Based on the number of employees
and federal contract activities, certain large employers are required to file an EEO-1 Report on an
annual basis.
The EEO-1 Report must be filed by:
(A) All private employers who are: (1) subject to Title VII of the Civil Rights Act of 1964 (as amended by the
Equal Employment Opportunity Act of 1972) with 100 or more employees EXCLUDING State and local
governments, primary and secondary school systems, institutions of higher education, Indian tribes and
tax-exempt private membership clubs other than labor organizations; OR (2) subject to Title VII who have
fewer than 100 employees if the company is owned or affiliated with another company, or there is
centralized ownership, control or management (such as central control of personnel policies and labor
relations) so that the group legally constitutes a single enterprise and the entire enterprise employs a total
of 100 or more employees.
(B) All federal contractors (private employers) who: (1) are not exempt as provided for by 41 CFR 60-1.5;
(2) have 50 or more employees, and (a) are prime contractors or first-tier subcontractors, and have a
contract, subcontract, or purchase order amounting to $50,000 or more; or (b) serve as depository of
Government funds in any amount; or (c) is a financial institution which is an issuing and paying agent for
U.S. Savings Bonds and Notes.
When filing the EEO-1 Report for the first time, go to the EEOC website at:
https://www.eeoc.gov/employers/eeo-1-survey
and select “First Time Filers”. If you have
previously registered, you should receive a notification letter by mail prior to the survey opening,
and will be informed when and how to file your report.
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