Fillable Printable Form 700-125-000

Form 700-125-000

F700-125-000 employer worksheet 09-2005

Department of Labor and Industries

Employment Standards Program

AGRICULTURAL EMPLOYER WORKSHEET

This worksheet is designed to help you know whether you are following state Agricultural Employment Standards and the Minimum Wage

Act when you employ workers. Filling out this worksheet is not required, but answering the checklist in the affirmative will help prepare

you to be successful when your employment practices are reviewed by a state or federal inspector.

Employer Information:

Business Name: ___________________________________________________________________________________________

Address: ___________________________________________________________________________________________

___________________________________________________________________________________________

Number of employees (approx): ____________________ Number of acres: ______________________

__________________________________________________________________________________________________________

Farm Labor Contractor:

I use a Farm Labor Contractor (FLC) to recruit, solicit, employ, supply, or transport workers Yes No

If yes, name of FLC: _________________________________________________________________________________________

I have verified with L&I that this FLC holds a valid FLC license and bond Yes No

FLC License #: ___________________ I have a written and signed contract with the FLC Yes No

I am keeping track of the workers of the FLC or I have verified that the FLC is keeping such records. The FLC law requires that either

the FLC or user of his/her services keeps records of names of workers, rate or rates of pay, number of piece work units if paid by piece

work, number of hours worked, total pay period earnings, deductions identified and listed separately, and net pay.

I am keeping the records: Yes No I have verified the FLC is keeping required records Yes No

To verify the status of the FLC, check L&I website: www.lni.wa.gov/WorkplaceRights/. In “Agricultural” section, click on “Farm Labor

Contractors”.

I have checked that the farm labor contractor is current with industrial insurance premiums Yes No

To verify industrial insurance premiums, check L&I website: www.lni.wa.gov/ClaimsIns. See middle box to right of the screen.

__________________________________________________________________________________________________________

Payment of Wages/Record Keeping:

I pay based on one or more of the following types of pay: Hourly Piecework Salary

Per pound Per can Per box Per bin

Per sack Per flat Other (specify): _________________________________________________

Hours are recorded by: Time clock/time cards Written time cards Sign-in sheet

Daily record book Attendance roster if used as time sheet

Calendar with employee names and hours per day Other _______________________________________________

I understand I am required to keep these records for a period of at least three years Yes No

F700-125-000 employer worksheet 09-2005

Paydays and Pay Statements: Paydays must be scheduled at no longer than monthly intervals.

I pay my employees Daily Weekly Twice per month Semi-monthly Monthly

I provide pay statements to each worker on payday Yes No Each pay statement contains the required information:

Employee name Yes No Total hours worked Yes No

Rate or rates of pay Yes No Piece rate if paid by piece rate Yes No

Number of piece work units earned if paid on piece work basis Yes No

Gross pay Yes No Dates of pay period Yes No

Purpose of each deduction shown on pay statement Yes No

Employer business name Yes No Employer address Yes No

Business telephone number Yes No

___________________________________________________________________________________________________________

Meal and Rest Periods: I understand the requirements for meal and rest periods for my employees Yes No

Meal breaks: If working more than 5 hours, employees must receive at least a 30-minute unpaid meal period; if they work more than

11 hours in a day, they must be allowed at least one additional 30-minute meal period. Rest breaks: Employees must be allowed at

least a 10-minute paid rest period in each 4-hour work period. If paid on a piece work basis, the rest period time must be included in

the number of hours for which the minimum wage must be paid.

My practice on meal periods is (describe): ________________________________________________________________________

__________________________________________________________________________________________________________

My practice on rest periods is (describe): _________________________________________________________________________

__________________________________________________________________________________________________________

Employment of Minors:

I employ minors (under age 18) Yes No I have a valid Minor Work Permit Yes No

I have my valid Minor Work Permit posted on my premises Yes No

I have completed and signed Parent/School Authorization forms on file for each of my minor workers Yes No

(I understand I do not need the school signature if minors work only during non-school weeks.)

Number of minors employed (approx) _________________

If yes, I schedule my minor workers for the hours permitted in each age group:

_____ 12/13 may be employed in the hand harvest of berries, bulbs, and cucumbers, and hand cultivation of spinach during

weeks when school is not in session. They may work the same hours as for 14/15 yr-old workers

_____ 14/15 may work up to 8 hrs per day and up to 40 hrs per week during non-school weeks. During school weeks they

may work up to 3 hrs on school days and up to 8 hrs on non-school days for a total of 21 hrs per week.

_____ 16/17 may work up to 10 hrs per day and 50 hrs per week during non-school weeks. During school weeks they

may work up to 4 hours per day on school days and up to 8 hrs per day on non-school days, for a total of 28 hrs per wk

I understand the prohibited occupations for minors and do not assign or allow them to work in any of those jobs Yes No

For more specific information and forms, check L&I’s publication ‘Young Workers in Agriculture’ (form #F700-096-909, the L&I website

at www.lni.wa.gov/WorkplaceRights (in Agricultural section, click on ‘Agricultural Jobs for Teens’), or contact an L&I office.

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