California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 8 - Office of the Director
Subchapter 4 - Labor Compliance Programs
Article 5 - Enforcement
Appendix C - Suggested Single Project Labor Compliance Review and Enforcement Report Form
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Awarding Body:
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Project Name:
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Name of Approved Labor Compliance Program:
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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
