Cal. Code Regs. Tit. 8, div. 1, ch. 8, subch. 4, art. 5, app C - Suggested Single Project Labor Compliance Review and Enforcement Report Form

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Awarding Body:

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Project Name:

___________________________

Name of Approved Labor Compliance Program:

___________________________

Bid Advertisement Date:

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Acceptance Date:

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Notice of Completion Recordation Date: Summary of Labor Compliance Activities

1. Contract Documents Containing Prevailing Wage Requirements (Identify)

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___________________________

___________________________

2. Prejob Conference(s) -- Attach list(s) of attendees and dates

3. Notification to Project Workers of Labor Compliance Program's Contact Person. (Explain Manner of Notification for each project work site.)

___________________________

___________________________

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4. Certified Payroll Record Review

a. CPRs Received From:

	Contractor/Subcontractor	For weeks ending ("w/e") through w/e
	___________________________	___________________________
	___________________________	___________________________
	___________________________	___________________________

b. Classifications identified in CPRs and applicable Prevailing Wage Determinations

	Classification	Determination No.
	___________________________	___________________________
	___________________________	___________________________
	___________________________	___________________________

5. Further investigation or audit due to CPR review, information or complaint from worker or other interested person, or other reason:

a. Independent Confirmation of CPR Data

	Contractor/Subcontractor	Worker Interviews (Yes/No)	Reconciled CPRs with Paychecks or Stubs (Yes/No)
	___________________________	___________________________	___________________________
	___________________________	___________________________	___________________________
	___________________________	___________________________	___________________________

b. Employer Payments (Health & Welfare, Pension, Vacation/Holiday) Confirmation

	Contractor/Subcontractor	Recipients of Employer Payments	Written confirmation Obtained (Yes/No)
	___________________________	___________________________	___________________________
	___________________________	___________________________	___________________________
	___________________________	___________________________	___________________________

c. Contributions to California Apprenticeship Council or Other Approved Apprenticeship Program

	Contractor/Subcontractor	Recipients of Contributions	Written confirmation Obtained (Yes/No)
	___________________________	___________________________	___________________________
	___________________________	___________________________	___________________________
	___________________________	___________________________	___________________________

d. Additional Wage Payments or Training Fund Contributions Resulting from Review of CPRs

	Contractor/ Subcontractor	Additional amounts Paid to Workers	Additional Training Fund	Explanation
	___________________________	___________________________	___________________________	*
	___________________________	___________________________	___________________________	*
	___________________________	___________________________	___________________________	*

* Use separate page(s) for explanation

6. Complaints Received Alleging Noncompliance with Prevailing Wage Requirements.

	Name of Complainant	Date Received	Resolution or Current Status
	___________________________	___________________________	*
	___________________________	___________________________	*
	___________________________	___________________________	*

*Use separate page(s) to explain resolution or current status

7. Requests for Approval of Forfeiture to Labor Commissioner

	Contractor/Subcontractor	Date of Request	Approved/Modified/Denied
	___________________________	___________________________	___________________________
	___________________________	___________________________	___________________________
	___________________________	___________________________	___________________________

8. Litigation Pending Under Labor Code Section 1742

	Contractor/Subcontractor	DIR Case Number
	___________________________	___________________________
	___________________________	___________________________
	___________________________	___________________________

9. (Check one): ___ Final report this project ___ Annual report this project

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Authorized Representative for Labor Compliance Program

Notes

Cal. Code Regs. Tit. 8, div. 1, ch. 8, subch. 4, art. 5, app C